The hinge plays a primary role in the hold and healing of a high tibial osteotomy (HTO). Weakening of the hinge is a risk factor for failure. The aim of our study was to determine whether the geometry of the saw blade's cutting edge impacts crack initiation or propagation on the hinge.

A certain cutting edge geometry exists that will reduce this risk.

A finite element model with transverse isotropic elastic bone properties was created. A 1.27-mm thick saw cut (full thickness in anteroposterior direction) was made leaving a 1cm lateral cortical hinge. Three different cutting edge geometries were compared: rectangular, U-shaped, V-shaped. Opening of the osteotomy was done over 1mm for 1 s by a load applied distally with the proximal portion fixed. In the first simulation, no crack was initiated at the hinge, while in the second simulation, the beginnings of a 2mm crack angled upward at 15° was added. These two simulations were used to identify whether a local stress riser was present at the hinge. This information was used to calculate the energy release rate to the hinge, which corresponds to the energy needed to initiate and propagate a crack on the hinge.

In the first simulation (no crack initiation), a rectangular saw blade geometry resulted in the lowest local stress concentration. In the second simulation (with crack initiation), the U-shaped geometry resulted in the lowest local stress concentration. The U-shaped geometry had the lowest energy release rate, meaning that it was the least likely to initiate and propagate a crack on the lateral cortical hinge.

Keeping the inherent limitations related to computer modelling in mind, our findings show that a U-shaped cutting edge is least likely to initiate or propagate a crack since it has the lowest energy release rate. This confirms our hypothesis.

V, expert opinion.