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Chen Z, Han J, Zhang J, Peng Y, Guo L, Chen S, Jin Z. Tibial post loading increases the risk of aseptic loosening of posterior-stabilized tibial prosthesis. Proc Inst Mech Eng H 2024:9544119241272756. [PMID: 39177049 DOI: 10.1177/09544119241272756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Aseptic loosening is the primary cause of failure following posterior-stabilized total knee arthroplasty. It is unclear whether tibial post loading of posterior-stabilized prosthesis increases the risk of aseptic loosening of the tibial prosthesis. The purpose of this study is to investigate the biomechanical effects of tibial post loading on the tibial prosthesis fixation interface during level walking, squatting, stair descent, and standing up-sitting down activities. In this paper, finite element models with and without post were established to compare the effects of tibial post loading on the von Mises stress of the proximal tibia, shear stress of the cement, and the bone-prosthesis interface micromotion during four physiological activities. The tibial post loading had an insignificant influence on tibial biomechanics and bone-prosthesis interface micromotion during leveling walking activity. However, compared to the insert without post condition, tibial post loading significantly increased the maximum tibial von Mises stress, the maximum shear stress in the medial of cement, and the bone-prosthesis interface peak micromotion by 912.84%, 612.77%, and 921.09%, respectively, at the moment of the maximum flexion angle for the stair descent activity, and 637.92%, 351.43%, and 519.13%, respectively, at the moment of the maximum flexion angle for the standing up-sitting down activity. Tibial post loading increased the risk of postoperative aseptic loosening of tibial prosthesis in patients with posterior-stabilized total knee arthroplasty, and it was recommended that the post-cam contact mechanism of posterior-stabilized prosthesis should be optimized to reduce the biomechanical impact of tibial post loading on tibial prosthesis fixation.
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Affiliation(s)
- Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, Shaanxi, China
| | - Jianian Han
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, Shaanxi, China
| | - Jing Zhang
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, Shaanxi, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Lei Guo
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, Shaanxi, China
| | - Shibin Chen
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, Shaanxi, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
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2
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Quevedo Gonzalez FJ, Lipman JD, Sculco PK, Sculco TP, De Martino I, Wright TM. An Anterior Spike Decreases Bone-Implant Micromotion in Cementless Tibial Baseplates for Total Knee Arthroplasty: A Biomechanical Study. J Arthroplasty 2024; 39:1323-1327. [PMID: 38000515 DOI: 10.1016/j.arth.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Cementless tibial baseplates in total knee arthroplasty include fixation features (eg, pegs, spikes, and keels) to ensure sufficient primary bone-implant stability. While the design of these features plays a fundamental role in biologic fixation, the effectiveness of anterior spikes in reducing bone-implant micromotion remains unclear. Therefore, we asked: Can an anterior spike reduce the bone-implant micromotion of cementless tibial implants? METHODS We performed computational finite element analyses on 13 tibiae using the computed tomography scans of patients scheduled for primary total knee arthroplasty. The tibiae were virtually implanted with a cementless tibial baseplate with 2 designs of fixation of the baseplate: 2 pegs and 2 pegs with an anterior spike. We compared the bone-implant micromotion under the most demanding loads from stair ascent between both designs. RESULTS Both fixation designs had peak micromotion at the anterior-lateral edge of the baseplate. The design with 2 pegs and an anterior spike had up to 15% lower peak micromotion and up to 14% more baseplate area with micromotions below the most conservative threshold for ingrowth, 20 μm, than the design with only 2 pegs. The greatest benefit of adding an anterior spike occurred for subjects who had the smallest area of tibial bone below the 20 μm threshold (ie, most at risk for failure to achieve bone ingrowth). CONCLUSIONS An anteriorly placed spike for cementless tibial baseplates with 2 pegs can help decrease the bone-implant micromotion during stair ascent, especially for subjects with increased bone-implant micromotion and risk for bone ingrowth failure.
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Affiliation(s)
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
| | - Ivan De Martino
- Department of Geriatric Science and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York
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3
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Lee HY, Boettner F, Blevins JL, Rodriguez JA, Lipman JD, Quevedo González FJ, Bostrom MP, Wright TM, Sculco PK. Hip joint center lateralization minimally affects the biomechanics of patient-specific flanged acetabular components: A computational model. J Orthop Res 2024. [PMID: 38669091 DOI: 10.1002/jor.25864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Patient-specific flanged acetabular components are utilized to treat failed total hip arthroplasties with large acetabular defects. Previous clinical studies from our institution showed that these implants tend to lateralize the acetabular center of rotation. However, the clinical impact of lateralization on implant survivorship is debated. Our goal was to develop a finite element model to quantify how lateralization of the native hip center affects periprosthetic strain and implant-bone micromotion distributions in a static level gait loading condition. To build the model, we computationally created a superomedial acetabular defect in a computed tomography 3D reconstruction of a native pelvis and designed a flanged acetabular implant to address this simulated bone defect. We modeled two implants, one with ~1 cm and a second with ~2 cm of hip center lateralization. We applied the maximum hip contact force and corresponding abductor force observed during level gait. The resulting strains were compared to bone fatigue strength (0.3% strain) and the micromotions were compared to the threshold for bone ingrowth (20 µm). Overall, the model demonstrated that the additional lateralization only slightly increased the area of bone at risk of failure and decreased the areas compatible with bone ingrowth. This computational study of patient-specific acetabular implants establishes the utility of our modeling approach. Further refinement will yield a model that can explore a multitude of variables and could be used to develop a biomechanically-based acetabular bone loss classification system to guide the development of patient-specific implants in the treatment of large acetabular bone defects.
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Affiliation(s)
- Haena-Young Lee
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Friedrich Boettner
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - Jason L Blevins
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - Jose A Rodriguez
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | | | - Mathias P Bostrom
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
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4
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Wearne LS, Rapagna S, Awadalla M, Keene G, Taylor M, Perilli E. Quantifying the immediate post-implantation strain field of cadaveric tibiae implanted with cementless tibial trays: A time-elapsed micro-CT and digital volume correlation analysis during stair descent. J Mech Behav Biomed Mater 2024; 151:106347. [PMID: 38181568 DOI: 10.1016/j.jmbbm.2023.106347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
Primary stability, the mechanical fixation between implant and bone prior to osseointegration, is crucial for the long-term success of cementless tibial trays. However, little is known about the mechanical interplay between the implant and bone internally, as experimental studies quantifying internal strain are limited. This study employed digital volume correlation (DVC) to quantify the immediate post-implantation strain field of five cadaveric tibiae implanted with a commercially available cementless titanium tibial tray (Attune, DePuy Synthes). The tibiae were subjected to a five-step loading sequence (0-2.5 bodyweight, BW) replicating stair descent, with concomitant time-elapsed micro-CT imaging. With progressive loads, increased compression of trabecular bone was quantified, with the highest strains directly under the posterior region of the tibial tray implant, dissipating with increasing distance from the bone-implant interface. After load removal of the last load step (2.5BW), residual strains were observed in all of the five tibiae, with residual strains confined within 3.14 mm from the bone-implant interface. The residual strain is reflective of the observed initial migration of cementless tibial trays reported in clinical studies. The presence of strains above the yield strain of bone accepted in literature suggests that inelastic properties should be included within finite element models of the initial mechanical environment. This study provides a means to experimentally quantify the internal strain distribution of human tibia with cementless trays, increasing the understanding of the mechanical interaction between bone and implant.
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Affiliation(s)
- Lauren S Wearne
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia; Flinders Microscopy and Microanalysis, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Maged Awadalla
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Greg Keene
- Orthopaedic Department, SportsMed, Adelaide, South Australia, Australia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.
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5
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Glenday JD, Vigdorchik JM, Sculco PK, Kahlenberg CA, Mayman DJ, Debbi EM, Lipman JD, Wright TM, González FJQ. A novel computational workflow to holistically assess total knee arthroplasty biomechanics identifies subject-specific effects of joint mechanics on implant fixation. J Biomech 2024; 164:111973. [PMID: 38325192 DOI: 10.1016/j.jbiomech.2024.111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Computational studies of total knee arthroplasty (TKA) often focus on either joint mechanics (kinematics and forces) or implant fixation mechanics. However, such disconnect between joint and fixation mechanics hinders our understanding of overall TKA biomechanical function by preventing identification of key relationships between these two levels of TKA mechanics. We developed a computational workflow to holistically assess TKA biomechanics by integrating musculoskeletal and finite element (FE) models. For our initial study using the workflow, we investigated how tibiofemoral contact mechanics affected the risk of failure due to debonding at the implant-cement interface using the four available subjects from the Grand Challenge Competitions to Predict In Vivo Knee Loads. We used a musculoskeletal model with a 12 degrees-of-freedom knee joint to simulate the stance phase of gait for each subject. The computed tibiofemoral joint forces at each node in contact were direct inputs to FE simulations of the same subjects. We found that the peak risk of failure did not coincide with the peak joint forces or the extreme tibiofemoral contact positions. Moreover, despite the consistency of joint forces across subjects, we observed important variability in the profile of the risk of failure during gait. Thus, by a combined evaluation of the joint and implant fixation mechanics of TKA, we could identify subject-specific effects of joint kinematics and forces on implant fixation that would otherwise have gone unnoticed. We intend to apply our workflow to evaluate the impact of implant alignment and design on TKA biomechanics.
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Affiliation(s)
- Jonathan D Glenday
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | | | - Peter K Sculco
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | | | - David J Mayman
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Eytan M Debbi
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Joseph D Lipman
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Timothy M Wright
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
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Post CE, Bitter T, Briscoe A, van Langen I, Fluit R, Verdonschot N, Janssen D. The Effect of Patient-Related Factors on the Primary Fixation of PEEK and Titanium Tibial Components: A Population-Based FE Study. Bioengineering (Basel) 2024; 11:116. [PMID: 38391602 PMCID: PMC10886164 DOI: 10.3390/bioengineering11020116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Polyetheretherketone (PEEK) is of interest as implant material for cementless tibial total knee arthroplasty (TKA) components due to its potential advantages. One main advantage is that the stiffness of PEEK closely resembles the stiffness of bone, potentially avoiding peri-prosthetic stress-shielding. When introducing a new implant material for cementless TKA designs, it is essential to study its effect on the primary fixation. The primary fixation may be influenced by patient factors such as age, gender, and body mass index (BMI). Therefore, the research objectives of this finite element (FE) study were to investigate the effect of material (PEEK vs. titanium) and patient characteristics on the primary fixation (i.e., micromotions) of a cementless tibial tray component. A total of 296 FE models of 74 tibiae were created with either PEEK or titanium material properties, under gait and squat loading conditions. Overall, the PEEK models generated larger peak micromotions than the titanium models. Differences were seen in the micromotion distributions between the PEEK and titanium models for both the gait and squat models. The micromotions of all tibial models significantly increased with BMI, while gender and age did not influence micromotions.
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Affiliation(s)
- Corine E Post
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Thom Bitter
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Adam Briscoe
- Invibio Ltd., Thornton Cleveleys FY5 4QD, Lancashire, UK
| | - Inger van Langen
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - René Fluit
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Faculty of Science and Engineering, University of Groningen, 9747 AG Groningen, The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Quevedo González FJ, Sculco PK, Kahlenberg CA, Mayman DJ, Lipman JD, Wright TM, Vigdorchik JM. Undersizing the Tibial Baseplate in Cementless Total Knee Arthroplasty has Only a Small Impact on Bone-Implant Interaction: A Finite Element Biomechanical Study. J Arthroplasty 2023; 38:757-762. [PMID: 36280162 DOI: 10.1016/j.arth.2022.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The tibial component in total knee arthroplasty (TKA) is often chosen to maximize coverage of the tibial cut, which can result in excessive internal rotation of the component. Optimal rotational alignment may require a smaller baseplate with suboptimal coverage that could threaten fixation. We asked: "does undersizing the tibial component of a cementless TKA to gain external rotation increase the risk of bone failure?" METHODS We developed computational finite element (FE) analysis models from the computed tomography (CT) scans of 12 patients scheduled for primary TKA. The models were implanted with a cementless tibial baseplate that maximized coverage and one or two sizes smaller and externally rotated by 5°. We calculated the risk of bone collapse under loads representative of stair ascent. RESULTS Undersizing the implant increased the area at risk of collapse for eight patients. However, the area at risk of collapse for the undersized implant (range, 5.2%-16.4%) was no different (P = .24) to the optimally sized implant (range, 4.5%-17.9%). The bone at risk of collapse was concentrated along the posterior edge of the implant. The area at risk of collapse was not proportional to implant size, and for four subjects undersizing the implant actually decreased the area at risk of collapse. CONCLUSION While implants should maximize coverage of the tibial cut and seek support on dense bone, undersizing the tibial component to gain external rotation had minimal impact on the load transfer to the underlying bone. This FE analysis model of a cementless tibial baseplate may require further validation and additional studies to investigate the long-term biomechanical effects of undersizing the tibial baseplate. In conclusion, while surgeons should strive to use the appropriate tibial baseplate for each patient, our model identified only minor biomechanical consequences of undersizing the implant for the immediate postoperative bone-implant interaction and implant subsidence.
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Affiliation(s)
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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8
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Teeter MG, Broberg JS, Howard JL, Lanting BA. Axial and sagittal rotation of cementless tibial baseplates occurs in bone under joint loading. J Arthroplasty 2023; 38:1166-1171. [PMID: 36893992 DOI: 10.1016/j.arth.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION There has been a recent increase in the use of cementless fixation for primary total knee arthroplasty (TKA). While the early results of contemporary cementless implants are promising, understanding the behavior of cementless tibial baseplates under loading remains an ongoing interest. The objective of this study was to identify the pattern of displacement that occurred under loading for a single cementless tibial baseplate design at one-year post-operation for stable and continuously migrating implants. METHODS There were 28 subjects from a previous trial of a pegged highly porous cementless tibial baseplate evaluated. Subjects underwent supine radiostereometric exams from two weeks through one year after surgery. At one year, subjects also underwent a standing radiostereometric exam. Fictive points on the tibial baseplate model were used to relate translations to anatomical locations. Migration over time was calculated to determine if subjects displayed stable or continuous migration. The magnitude of inducible displacement between the supine and standing exams was calculated. RESULTS Inducible displacement patterns were similar between stable and continuously migrating tibial baseplates. Displacements were greatest in the anterior-posterior axis followed by the lateral-medial axis. Correlation of displacements between adjacent fictive points in these axes indicated an axial rotation of the baseplate occurred under loading (r2 = 0.689-0.977, P< 0.001). Less displacement occurred in the superior-inferior axis and correlations indicated an anterior-posterior tilt of the baseplate occurred under loading (r2 = 0.178-0.226, P = 0.009-0.023). DISCUSSION From supine to standing position the predominant pattern of displacement for this cementless tibial baseplate was axial rotation, with some subjects also displaying an anterior-posterior tilt.
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Affiliation(s)
- Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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LaMonica J, Pham N, Milligan K, Tommasini SM, Schwarzkopf R, Parisi R, Wiznia DH. How metal augments, polyethylene thickness and stem length affect tibial baseplate load transfer in revision total knee arthroplasty. Knee 2023; 40:283-291. [PMID: 36529046 DOI: 10.1016/j.knee.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is unclear howmetal augments,polyethylene (PE) liner thickness, and length of cemented stemcontribute to load transferwhen reconstructing uncontained tibial metaphyseal bone loss of Anderson Orthopedic Research Institute (AORI) Type II defects during revision total knee arthroplasty (rTKA).The aimof this study is to understand the impact of these three variableson load transfer through the tibial baseplate. For a fixed defect depth, we hypothesized that there is a particular combination of liner and augment thickness and stem length that minimizes bone stress, reducing the risk of aseptic loosening. METHODS We conducted a finite element analysis (FEA) to model stresses at the bone-cement interface with different iterations of metal augments, PE liner thicknesses andfully-cemented stems lengths. RESULTS For a 20 mm tibial defect, constructs with thicker metal augments and thinner polyethylene liners were superior. Constructswith a fully cemented stem further reduced bone stress on the tibial plateau. Bone stress was lowest when a 100 mm fully-cemented stem was used, while stems between 30 mm - 80 mm produced similar results. CONCLUSIONS When addressing a tibial bone defect of AORI Type II in rTKA, our FEA model demonstrates that surgeons should opt to use the thickest metal augments in combination with afully-cemented stem with an added length of at least 30 mm, which allows for surgical flexibility together with the most stable construct.Our study is notably limited by lack of modeling of knee joint moments, which are important when considering micromotion, bone-implant interface and stem effectiveness.
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Affiliation(s)
- Julia LaMonica
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA; Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, CT 06473, USA
| | - Nguyen Pham
- Department of Mechanical Engineering, Yale University School of Engineering & Applied Sciences, New Haven, CT 06511, USA
| | - Kenneth Milligan
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Steven M Tommasini
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Ran Schwarzkopf
- Department of Orthopaedics, New York University Langone Orthopedic Hospital, New York, NY 10003, USA
| | | | - Daniel H Wiznia
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
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Mosich GM, Potter HG, Koff MF, Sacher SE, Mishu M, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging to Study Detailed Bone Apposition and Fixation of Cementless Knee System Compared to Cemented Total Knee Replacements. Arthroplast Today 2022; 17:126-131. [PMID: 36082282 PMCID: PMC9445226 DOI: 10.1016/j.artd.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Gina M. Mosich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sara E. Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Mithun Mishu
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H. Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
- Corresponding author. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 606 1510.
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Glenday JD, Wright TM, Lipman JD, Sculco PK, Mayman DJ, Vigdorchik JM, Quevedo-Gonzalez FJ. Effect of varus alignment on the bone-implant interaction of a cementless tibial baseplate during gait. J Orthop Res 2022; 40:816-825. [PMID: 34231249 DOI: 10.1002/jor.25129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Component alignment in total knee arthroplasty is a determining factor for implant longevity. Mechanical alignment, which provides balanced load transfer, is the most common alignment strategy. However, a retrospective review found that varus alignment, which could lead to unbalanced loading, can happen in up to 18% of tibial baseplates. This may be particularly burdensome for cementless tibial baseplates, which require low bone-implant micromotion and avoidance of bone overload to obtain bone ingrowth. Our aim was to assess the effect of varus alignment on the bone-implant interaction of cementless baseplates. We virtually implanted 11 patients with knee OA with a modern cementless tibial baseplate in mechanical alignment and in 2° of tibial varus alignment. We performed finite element simulations throughout gait, with loading conditions derived from literature. Throughout the stance phase, varus alignment had greater micromotion and percentage of bone volume at risk of failure than mechanical alignment. At mid-stance, when the most critical conditions occurred, the average increase in peak micromotion and amount of bone at risk of failure due to varus alignment were 79% and 59%, respectively. Varus alignment also resulted in the decrease of the surface area with micromotion compatible with bone ingrowth. However, for both alignments, this surface area was larger than the average area of ingrowth reported for well-fixed implants retrieved post-mortem. Our findings suggest that small varus deviations from mechanical alignment can adversely impact the biomechanics of the bone-implant interaction for cementless tibial baseplates during gait; however, the clinical implications of such changes remain unclear.
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de Vries E, Sánchez E, Janssen D, Matthews D, van der Heide E. Predicting friction at the bone – Implant interface in cementless total knee arthroplasty. J Mech Behav Biomed Mater 2022; 128:105103. [DOI: 10.1016/j.jmbbm.2022.105103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Quevedo González FJ, Meyers KN, Schraut N, Mehrotra KG, Lipman JD, Wright TM, Ast MP. Do Metaphyseal Cones and Stems Provide Any Biomechanical Advantage for Moderate Contained Tibial Defects in Revision TKA? A Finite-Element Analysis Based on a Cadaver Model. Clin Orthop Relat Res 2021; 479:2534-2546. [PMID: 34351312 PMCID: PMC8509913 DOI: 10.1097/corr.0000000000001912] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Satisfactory management of bone defects is important to achieve an adequate reconstruction in revision TKA. Metaphyseal cones to address such defects in the proximal tibia are increasingly being used; however, the biomechanical superiority of cones over traditional techniques like fully cementing the implant into the defect has not yet been demonstrated. Moreover, although long stems are often used to bypass the defects, the biomechanical efficacy of long stems compared with short, cemented stems when combined with metaphyseal cones remains unclear. QUESTIONS/PURPOSES We developed and validated finite-element models of nine cadaveric specimens to determine: (1) whether using cones for addressing moderate metaphyseal tibial defects in revision TKA reduces the risk of implant-cement debonding compared with cementing the implant alone, and (2) when using metaphyseal cones, whether long, uncemented stems (or diaphyseal-engaging stems) reduce the risk of implant-cement debonding and the cone-bone micromotions compared with short, cemented stems. METHODS We divided nine cadaveric specimens (six male, three female, aged 57 to 73 years, BMI 24 to 47 kg/m2) with standardized tibial metaphyseal defects into three study groups: no cone with short (50-mm) cemented stem, in which the defect was filled with cement; cone with short (50-mm) cemented stem, in which a metaphyseal cone was implanted before cementing the implant; and cone with long, diaphyseal-engaging stem, which received a metaphyseal cone and the largest 150-mm stem that could fit the diaphyseal canal. The specimens were implanted and mechanically tested. Then, we developed and validated finite-element models to investigate the interaction between the implant and the bone during the demanding activity of stair ascent. We quantified the risk of implant debonding from the cement mantle by comparing the axial and shear stress at the cement-implant interface against an experimentally derived interface failure index criterion that has been previously used to quantify the risk of cement debonding. We considered the risk of debonding to be minimal when the failure index was below 10% of the strength of the interface (or failure index < 0.1). We also quantified the micromotion between the cone and the bone, as a guide to the likelihood of fixation by bone ingrowth. To this end, we assumed bone ingrowth for micromotion values below the most restrictive reported threshold for bone ingrowth, 20 µm. RESULTS When using a short, 50-mm cemented stem and cement alone to fill the defect, 77% to 86% of the cement-implant interface had minimal risk of debonding (failure index < 0.1). When using a short, 50-mm cemented stem with a cone, 87% to 93% of the cement-implant interface had minimal debonding risk. When combining a cone with a long (150-mm) uncemented stem, 92% to 94% of the cement-implant interface had minimal debonding risk. The differences in cone-bone micromotion between short, cemented stems and long, uncemented stems were minimal and, for both configurations, most cones had micromotions below the most restrictive 20-µm threshold for ingrowth. However, the maximum micromotion between the cone and the bone was in general smaller when using a long, uncemented stem (13-23 µm) than when using a short, cemented stem (11-31 µm). CONCLUSION Although the risk of debonding was low in all cases, metaphyseal cones help reduce the biomechanical burden on the implant-cement interface of short-stemmed implants in high-demand activities such as stair ascent. When using cones in revision TKA, long, diaphyseal-engaging stems did not provide a clear biomechanical advantage over short stems. Future studies should explore additional loading conditions, quantify the interspecimen variability, consider more critical defects, and evaluate the behavior of the reconstructive techniques under repetitive loads. CLINICAL RELEVANCE Cones and stems are routinely used to address tibial defects in revision TKA. Despite our finding that metaphyseal cones may help reduce the risk of implant-cement debonding and allow using shorter stems with comparable biomechanical behavior to longer stems, either cones or cement alone can provide comparable results in contained metaphyseal defects. However, longer term clinical studies are needed to compare these techniques over time.
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Affiliation(s)
| | - Kathleen N. Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Joseph D. Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Timothy M. Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Michael P. Ast
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
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Steineman BD, González FJQ, Sturnick DR, Deland JT, Demetracopoulos CA, Wright TM. Biomechanical evaluation of total ankle arthroplasty. Part I: Joint loads during simulated level walking. J Orthop Res 2021; 39:94-102. [PMID: 33146417 PMCID: PMC7749051 DOI: 10.1002/jor.24902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/25/2020] [Accepted: 10/31/2020] [Indexed: 02/04/2023]
Abstract
In total ankle arthroplasty, the interaction at the joint between implant and bone is driven by a complex loading environment. Unfortunately, little is known about the loads at the ankle during daily activities since earlier attempts use two- or three-dimensional models to explore simplified joint mechanics. Our goal was to develop a framework to calculate multi-axial loads at the joint during simulated level walking following total ankle arthroplasty. To accomplish this, we combined robotic simulations of level walking at one-quarter bodyweight in three cadaveric foot and ankle specimens with musculoskeletal modeling to calculate the multi-axial forces and moments at the ankle during the stance phase. The peak compressive forces calculated were between 720 and 873 N occurring around 77%-80% of stance. The peak moment, which was the internal moment for all specimens, was between 6.1 and 11.6 N m and occurred between 72% and 88% of the stance phase. The peak moment did not necessarily occur with the peak force. The ankle joint loads calculated in this study correspond well to previous attempts in the literature; however, our robotic simulator and framework provide an opportunity to resolve the resultant three-dimensional forces and moments as others have not in previous studies. The framework may be useful to calculate ankle joint loads in cadaveric specimens as the first step in evaluating bone-implant interactions in total ankle replacement using specimen specific inputs. This approach also provides a unique opportunity to evaluate changes in joint loads and kinematics following surgical interventions of the foot and ankle.
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Affiliation(s)
- Brett D. Steineman
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | | | - Daniel R. Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | | | | | - Timothy M. Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
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González FJQ, Steineman BD, Sturnick DR, Deland JT, Demetracopoulos CA, Wright TM. Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone-implant interaction. J Orthop Res 2021; 39:103-111. [PMID: 33030768 PMCID: PMC7748995 DOI: 10.1002/jor.24876] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Finite element (FE) models to evaluate the burden placed on the interaction between total ankle arthroplasty (TAA) implants and the bone often rely on peak axial forces. However, the loading environment of the ankle is complex, and it is unclear whether peak axial forces represent a challenging scenario for the interaction between the implant and the bone. Our goal was to determine how the loads and the design of the fixation of the tibial component of TAA impact the interaction between the implant and the bone. To this end, we developed a framework that integrated robotic cadaveric simulations to determine the ankle kinematics, musculoskeletal models to determine the ankle joint loads, and FE models to evaluate the interaction between TAA and the bone. We compared the bone-implant micromotion and the risk of bone failure of three common fixation designs for the tibial component of TAA: spikes, a stem, and a keel. We found that the most critical conditions for the interaction between the implant and the bone were dependent on the specimen and the fixation design, but always involved submaximal forces and large moments. We also found that while the fixation design influenced the distribution and the peak value of bone-implant micromotion, the amount of bone at risk of failure was specimen dependent. To account for the most critical conditions for the interaction between the implant and the bone, our results support simulating multiple specimens under complex loading profiles that include multiaxial moments and span entire activity cycles.
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Affiliation(s)
| | - Brett D Steineman
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Daniel R Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Jonathan T. Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
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