Analysis of Surgical Parameters in High Tibial Osteotomy: Effects on Resultant Tibiofemoral Force Position

Unintended under- and overcorrections remain a significant challenge in medial open wedge High Tibial Osteotomy (owHTO). Achieving balanced load distribution is a central focus in HTO, yet most studies concentrate on the classical two-dimensional (2D) standing scenario rather than examining the complexities of three-dimensional (3D) load behavior during dynamic motions. This study aimed to investigate the biomechanical effects of key surgical parameters—wedge height, hinge axis, and osteotomy technique—on the position of the resultant force on the tibial plateau during knee flexion. A multibody simulation was conducted on 10 3D computer models of the tibia. The position of the center of pressure (CoP) on the tibial plateau was measured and compared across different surgical scenarios. Results indicate that increasing wedge height causes lateral CoP displacement, with the effect decreasing at higher flexion angles, while anteromedial axial rotation of the hinge axis led to posterior CoP shifts. A comparison of supratuberositary to infratuberositary osteotomies revealed a medial CoP displacement during late flexion (>5°).