Integration of external knee joint loads in the pre-surgical planning of high tibial osteotomy: a proof-of-concept study

High tibial osteotomy (HTO) is a surgical procedure used to correct leg misalignments that could induce osteoarthritis by redistributing the knee joint loads. In this study, the two musculoskeletal (MSK) models, created from medical images, were modified according to HTO surgical pre-operative plans, and the knee adduction moments (KAM) occurring during walking and stair climbing computed before and after the virtual surgeries. These simulations demonstrated the effectiveness of the surgical procedure in reducing the KAM by up to 32% at its peak value, while a sensitivity study suggested that including dynamic loads in the pre-operative planning could optimize the HTO long-term outcome. The study is a development step in view of a planned clinical trial.