Abstract: BACKGROUND: High tibial osteotomy is an effective treatment for certain patients with knee osteoarthritis; however, traditional T-shaped plates have multiple limitations.
OBJECTIVE: To compare the biomechanical performance of titanium alloy porous blocks with that of conventional T-shaped plates and bone grafting schemes in high tibial osteotomy using finite element analysis.
METHODS: A computer simulation experiment was conducted, performing three-dimensional finite element analysis on a 55-year-old male patient who underwent high tibial osteotomy. Three different implant geometries were constructed: a conventional T-shaped plate high tibial osteotomy model (Model A), a bone graft–augmented high tibial osteotomy model (Model B), and a titanium alloy porous block–augmented high tibial osteotomy model (Model C). These models were used to evaluate the effects of each implant on total displacement and stress distribution under two loading conditions: standing and initial rising from a seated position. 
RESULTS AND CONCLUSION: (1) Validation results confirmed that the finite element models were effective. (2) In terms of stability, Model C (titanium alloy porous block–augmented high tibial osteotomy) demonstrated the best reduction in total displacement, with maximum displacements under both standing and rising conditions significantly lower than those of the other two models. (3) Stress analysis revealed that Model C’s T-shaped plate experienced the lowest stress values: (40.9±36.5) MPa (standing) and (66.1±44.7) MPa (rising), representing reductions of 91.2% and 92.9%, respectively, compared with Model A. Additionally, Model C exhibited significantly lower mean stress at the lateral hinge region than Models A and B, indicating a reduced risk of lateral hinge fracture. Stress distribution at the proximal osteotomy contact surface and hinge region showed that Model C provided more favorable stress stimulation, which may promote bone healing while lowering hinge fracture risk. (4) It is indicated that the titanium alloy porous block not only enhances initial stability at the osteotomy site but, by optimizing stress transmission pathways and offering a biocompatible environment, also addresses shortcomings in mechanical stability and biological integration found in existing plating techniques. These findings suggest promising clinical application potential.

Key words: high tibial osteotomy, titanium alloy porous block, T-shaped plate, autograft, allograft, finite element analysis