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Wu D, Wang Q, Tsai HK, Zhou S, Zheng D, Jiang Q, Xu Z. Bond strength of metal-free polyether-ether-ketone knee prostheses compared to metal knee prostheses with bone cement: A preliminary in vitro study. J Orthop Surg (Hong Kong) 2023; 31:10225536231217537. [PMID: 37997347 DOI: 10.1177/10225536231217537] [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] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is the most effective treatment for advanced-stage knee arthritis, and the majority of knee prostheses are made of metal. Nevertheless, metal prostheses still have several problems. The objective of this study is to introduce new metal-free knee prostheses made of polyether-ether-ketone (PEEK) and to compare their cement bond strength with metal prostheses. METHODS Twelve sets of knee prostheses were divided into four groups (unloaded PEEK, unloaded Metal, 10 million cycles (MC) PEEK, 10 MC Metal, N = 3 each), and then attached to composite bones using bone cement. Both the 10 MC PEEK and 10 MC Metal groups were subjected to dynamic gait simulations of 10 MC, whereas the other two sets were not. Afterwards, a pull-off strength test was performed on the femoral prostheses and a shear strength test was performed on the tibial prostheses. RESULTS No apparent cracks were observed in the bone cement after subjecting the PEEK and Metal groups to 10 million cycles of dynamic simulation. No statistically significant differences were observed (p > .05) in the strength tests for unloaded PEEK vs. unloaded Metal, 10 MC PEEK vs.10 MC Metal in the femoral pull-off test, and for unloaded PEEK vs. unloaded Metal in the tibial shear test. The shear strength of 10 MC PEEK was significantly lower (p < .05) compared to that of 10 MC Metal. CONCLUSIONS By comparing the force analysis of previous investigations on knee prostheses with the failure pattern observed in the PEEK knee prosthesis of this study, which replicates that of the metal prosthesis. We believe that the combination of the peek knee prosthesis with bone cement is reliable. We anticipate that metal-free PEEK knee prostheses will find application in Total Knee Arthroplasty (TKA) in the future, thereby benefiting patients.
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Affiliation(s)
- Dengxian Wu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Qianjin Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Hung-Kang Tsai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Sheng Zhou
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Donggui Zheng
- Suzhou SinoMed Biomaterials Co., Ltd, Suzhou, Jiangsu, PR China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
| | - Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, PR China
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Van Laarhoven SN, Te Molder MEM, Van Hellemondt GG, Heesterbeek PJC. Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up. Acta Orthop 2023; 94:185-190. [PMID: 37096567 PMCID: PMC10127004 DOI: 10.2340/17453674.2023.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND AND PURPOSE Rotating hinged knee implants are highly constrained prostheses used in cases in which adequate stability is mandatory. Due to their constraint nature, multidirectional stresses are directed through the bone-cement-implant interface, which might affect fixation and survival. The goal of this study was to assess micromotion of a fully cemented rotating hinged implant using radiostereometric analysis (RSA). PATIENTS AND METHODS 20 patients requiring a fully cemented rotating hinge-type implant were included. RSA images were taken at baseline, 6 weeks, and 3, 6, 12, and 24 months postoperatively. Micromotion of femoral and tibial components referenced to markers in the bone was assessed with model-based RSA software, using implant CAD models. Total translation (TT), total rotation (TR), and maximal total point motion (MTPM) were calculated (median and range). RESULTS At 2 years, TTfemur was 0.38 mm (0.15-1.5), TRfemur was 0.71° (0.37-2.2), TTtibia was 0.40 mm (0.08-0.66), TRtibia was 0.53° (0.30-2.4), MTPMfemur was 0.87 mm (0.54-2.8), and MTPMtibia was 0.66 mm (0.29-1.6). Femoral components showed more outliers (> 1 mm, > 1°) compared with tibial components. CONCLUSION Fixation of this fully cemented rotating hinge-type revision implant seems adequate in the first 2 years after surgery. Femoral components showed more outliers, in contrast to previous RSA studies on condylar revision total knee implants.
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Wan Q, Zhang A, Liu Y, Chen H, Zhang J, Xue H, Han Q, Wang J. The influence of body weight index on initial stability of uncemented femoral knee protheses: A finite element study. Heliyon 2023; 9:e13819. [PMID: 36895366 PMCID: PMC9988490 DOI: 10.1016/j.heliyon.2023.e13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Background and objective Obesity is one of the risk factors for osteoarthritis. The end-stage treatment for osteoarthritis is total knee arthroplasty (TKA). However, it remains controversial whether a high body mass index (BMI) affects the initial stability of the femoral prosthesis after TKA. Finite element analysis (FEA) was used to investigate this question in this study. Methods Four femur models that assembled with TKA femoral components were reconstructed and divided into high BMI group and normal BMI group. The three-dimensional femurs were modeled and assigned inhomogeneous materials based on computed tomography (CT) images. Then each FEA model was applied with gait and deep bend loading conditions to evaluate the maximum principal strain on the distal femur and the relative micromotion between the femur and prosthesis. Results The mean strain of the high BMI group increased by 32.7% (936.9 με versus 706.1 με) and 50.9% (2064.5 με versus 1368.2 με) under gait and deep bend loading conditions, respectively, compared to the normal BMI group. Meanwhile, the mean micromotion of the high BMI group increased by 41.6% (2.77 μm versus 1.96 μm) and 58.5% (62.1 μm versus 39.2 μm), respectively. Under gait condition, the maximum micromotion for high BMI group was 33.8 μm and would compromise the initial stability. Under deep bend condition, the maximum strain and micromotion exceeded -7300 με and 28 μm for both groups. Conclusion High BMI caused higher strain on the bone and higher micromotion between the prosthesis and the femur. Gait activities could be risky for prosthesis stability in high BMI group while be safe in normal group. Deep bend activities were highly dangerous for both groups with high BMI and normal BMI and should be avoided.
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Affiliation(s)
- Qian Wan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Aobo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Yang Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Hao Chen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Jiangbo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Haowen Xue
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130000, China
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Liu T, Ead M, Cruz SDV, Jomha N, Adeeb S, El-Rich M, Duke K, Westover L. Polycarbonate-urethane coating can significantly improve talus implant contact characteristics. J Mech Behav Biomed Mater 2021; 125:104936. [PMID: 34749205 DOI: 10.1016/j.jmbbm.2021.104936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
Talus implants can be utilized in cases of talus avascular necrosis and has been regarded as a promising treatment method. However, existing implants are made of stiff materials that directly oppose natural cartilage. The risk of long-term cartilage wear and bone fracture from the interaction between the cartilage and stiff implant surfaces has been documented in post-hemiarthroplasty of the hip, knee and ankle joints. The aim is to explore the effects of adding a layer of compliant material (polycarbonate-urethane; PCU) over a stiff material (cobalt chromium) in talus implants. To do so, we obtained initial ankle geometry from four cadaveric subjects in neutral standing to create the finite element models. We simulated seven models for each subject: three different types of talus implants, each coated with and without PCU, and a biological model. In total, we constructed 28 finite element models. By comparing the contact characteristics of the implant models with their respective biological model counterparts, our results showed that PCU coated implants have comparable contact area and contact pressure to the biological models, whereas stiff material implants without the PCU coating all have relatively higher contact pressure and smaller contact areas. These results confirmed that adding a layer of compliant material coating reduces the contact pressure and increases the contact area which in turn reduces the risk of cartilage wear and bone fracture. The results also suggest that there can be clinical benefits of adding a layer of compliant material coating on existing stiff material implants, and can provide valuable information towards the design of more biofidelic implants in the future.
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Affiliation(s)
- Tao Liu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Maha Ead
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Shaira D V Cruz
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr Jomha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kajsa Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Pant A, Paul E, Niebur GL, Vahdati A. Integration of mechanics and biology in computer simulation of bone remodeling. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2021; 164:33-45. [PMID: 33965425 DOI: 10.1016/j.pbiomolbio.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/27/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
Bone remodeling is a complex physiological process that spans across multiple spatial and temporal scales and is regulated by both mechanical and hormonal cues. An imbalance between bone resorption and bone formation in the process of bone remodeling may lead to various bone pathologies. One powerful and non-invasive approach to gain new insights into mechano-adaptive bone remodeling is computer modeling and simulation. Recent findings in bone physiology and advances in computer modeling have provided a unique opportunity to study the integration of mechanics and biology in bone remodeling. Our objective in this review is to critically appraise recent advances and developments and discuss future research opportunities in computational bone remodeling approaches that enable integration of mechanics and cellular and molecular pathways. Based on the critical appraisal of the relevant recent published literature, we conclude that multiscale in silico integration of personalized bone mechanics and mechanobiology combined with data science and analytics techniques offer the potential to deepen our knowledge of bone remodeling and provide ample opportunities for future research.
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Affiliation(s)
- Anup Pant
- Multi-disciplinary Mechanics and Modeling Laboratory, Department of Engineering, East Carolina University, Greenville, NC 27858, USA
| | - Elliot Paul
- Multi-disciplinary Mechanics and Modeling Laboratory, Department of Engineering, East Carolina University, Greenville, NC 27858, USA
| | - Glen L Niebur
- Tissue Mechanics Laboratory, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Ali Vahdati
- Multi-disciplinary Mechanics and Modeling Laboratory, Department of Engineering, East Carolina University, Greenville, NC 27858, USA.
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Total knee arthroplasty application of polyetheretherketone and carbon-fiber-reinforced polyetheretherketone: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 100:70-81. [DOI: 10.1016/j.msec.2019.02.082] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
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Correa TA, Pal B, van Arkel RJ, Vanacore F, Amis AA. Reduced tibial strain-shielding with extraosseous total knee arthroplasty revision system. Med Eng Phys 2018; 62:22-28. [PMID: 30314902 PMCID: PMC6236098 DOI: 10.1016/j.medengphy.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022]
Abstract
A novel extracortical support system for revision of failed knee prostheses. Shown to reduce metaphyseal stress-shielding versus intramedullary stem fixation. Reduces bone loss and enables bone grafting of defects after implant loosening. Enables use of conventional prosthesis in a revision scenario.
Background Revision total knee arthroplasty (RTKA) has poorer results than primary total knee arthroplasty (TKA), and the prostheses are invasive and cause strain-shielding of the bones near the knee. This paper describes an RTKA system with extracortical fixation. It was hypothesised that this would reduce strain-shielding compared with intramedullary fixation. Methods Twelve replica tibiae were prepared for full-field optical surface strain analysis. They were either left intact, implanted with RTKA components with cemented intramedullary fixation stems, or implanted with a novel design with a tibial tray subframe supported by two extracortical fixation plates and screw fixation. They were loaded to simulate peak walking and stair climbing loads and the surface strains were measured using digital image correlation. The measurements were validated with strain gauge rosettes. Results Compared to the intact bone model, extracortical fixation reduced surface strain-shielding by half versus intramedullary fixation. For all load cases and bone regions examined, the extracortical implant shielded 8–27% of bone strain, whereas the intramedullary component shielded 37–56%. Conclusions The new fixation design, which offers less bone destruction than conventional RTKA, also reduced strain-shielding. Clinically, this design may allow greater rebuilding of bone loss, and should increase long-term fixation.
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Affiliation(s)
- Tomas A Correa
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK.
| | - Bidyut Pal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK; School of Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK.
| | - Richard J van Arkel
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK.
| | - Felice Vanacore
- Department of Orthopaedics and Traumatology, Marche Polytechnic University, Ancona, Italy.
| | - Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK; Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, London W6 8RF, UK.
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Conlisk N, Howie CR, Pankaj P. Optimum stem length for mitigation of periprosthetic fracture risk following primary total knee arthroplasty: a finite element study. Knee Surg Sports Traumatol Arthrosc 2018; 26:1420-1428. [PMID: 27812774 PMCID: PMC5907626 DOI: 10.1007/s00167-016-4367-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Due to age-related changes to the material properties and thinning of the cortical bone structure, older patients with osteoporosis may be at greater risk of femoral fracture following total knee arthroplasty. This study investigates whether there is a potential role for stemmed prostheses in such scenarios to help mitigate peri-implant fracture risk, and if so what should the optimum stem length be to balance surgical bone loss with reduced fracture risk. METHODS Finite element models of the distal femur implanted with four different implant types: a posterior stabilising implant, a total stabilising implant with short stem (12 mm × 50 mm), a TS implant with medium stem (12 mm × 75 mm), and a TS implant with long stem (12 mm × 100 mm), were developed and analysed in this study. Osteoporotic properties were applied to the implanted femurs and the periprosthetic stresses and strains of each were recorded. RESULTS All stem lengths examined were found to lead to a reduction in periprosthetic stress in comparison with a primary stemless implant, with short-, medium-, and long-stemmed implants leading to an 11, 26, and 29% reduction in stress, respectively. CONCLUSION The results of this study show that periprosthetic stress and therefore fracture risk in old osteoporotic patients may be reduced through the use of stemmed femoral components. Of the three stems investigated, a medium-length stem is found to represent the best balance between bone preservation at the time of surgery and reduction in periprosthetic stress following implantation.
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Affiliation(s)
- Noel Conlisk
- Orthopaedic Engineering, The University of Edinburgh, Edinburgh, UK. .,School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK. .,Institute for Bioengineering, The University of Edinburgh, Faraday Building, The King's Buildings, Edinburgh, EH9 3JL, UK.
| | - Colin R. Howie
- Orthopaedic Engineering, The University of Edinburgh, Edinburgh, UK ,Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- Orthopaedic Engineering, The University of Edinburgh, Edinburgh, UK ,School of Engineering, The University of Edinburgh, Edinburgh, UK ,Institute for Bioengineering, The University of Edinburgh, Faraday Building, The King’s Buildings, Edinburgh, EH9 3JL UK
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Conlisk N, Howie CR, Pankaj P. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit. Knee 2017; 24:994-1005. [PMID: 28778499 DOI: 10.1016/j.knee.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/12/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. METHODS Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. RESULTS The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. CONCLUSION In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; School of Engineering, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Howie
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, UK
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de Ruiter L, Janssen D, Briscoe A, Verdonschot N. A preclinical numerical assessment of a polyetheretherketone femoral component in total knee arthroplasty during gait. J Exp Orthop 2017; 4:3. [PMID: 28144820 PMCID: PMC5285288 DOI: 10.1186/s40634-017-0078-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 11/28/2022] Open
Abstract
Background Conventional total knee replacement designs show high success rates but in the long term, the stiff metal components may affect bone quality of the distal femur. In this study we introduce an all-polymer total knee replacement device containing a PEEK femoral component on an UHMWPE tibial implant and study its mechanical integrity, fixation, and stress shielding of the periprosthetic femur. Methods The implant was analysed in finite element simulations of level gait, adopted from the ISO 14243-1 standard. Mechanical integrity of the implant and underlying cement mantle were tested, and the fixation strength of the cement-implant interface was studied. Stress shielding was assessed based on strain energy density distributions in the distal femur. We compared PEEK and CoCr implants for mechanical performance and fixation, and compared both versions against an intact case to determine the change in bone strain energy density. Results The mechanical integrity of the PEEK and CoCr components was similar in magnitude, but differences in stress patterns were found. Moreover, the cement mantle was loaded more heavily in the CoCr configuration. Under similar interface properties, the CoCr-cement interface was more at risk of failure than the PEEK-cement interface. The bone strain energy density distribution of the PEEK implant was similar to the intact case, while the CoCr implant showed signs of stress shielding, and a different distribution than the intact and PEEK models. Conclusions During gait, the PEEK femoral component performed similarly to CoCr, with no added risk for the cement mantle. The reduction in stress shielding for PEEK was evident and confirms the potential reduction in long-term loss of bone stock for this all-polymer knee implant.
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Affiliation(s)
- Lennert de Ruiter
- Orthopaedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Adam Briscoe
- Invibio Ltd, Thornton Cleveleys, Lancashire, FY5 4QD, UK
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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Comparable Stability of Cemented vs Press-Fit Placed Stems in Revision Total Knee Arthroplasty With Mild to Moderate Bone Loss: 6.5-Year Results From a Randomized Controlled Trial With Radiostereometric Analysis. J Arthroplasty 2017; 32:197-201. [PMID: 27554783 DOI: 10.1016/j.arth.2016.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Short-term stability after revision total knee arthroplasty (TKA) with either fully cemented or hybrid-placed implants is comparable. Interestingly, implant micromotion >1 mm/degree occurred with both techniques which might increase the risk of loosening in the midterm or long-term. Therefore, the present study investigated midterm stability and clinical results of fully cemented vs hybrid-placed revision TKA, with mild to moderate bone loss, using radiostereometric analysis (RSA). METHODS This study involves the prolonged follow-up of a previous randomized controlled trial. RSA images taken at baseline, 6 weeks, 3 and 6 months, and 1, 2 and 6.5 years of follow-up were analyzed. Stability of the femoral and tibial implants was evaluated using total translation and rotation, based on the micromotion determined with model-based RSA. RESULTS Of the 30 patients who completed the 2-year follow-up in the original randomized controlled trial, 23 (12 cement, 11 hybrid) were available for follow-up at 6.5-year (range 5.4-7.3). There were no differences in median total translation and rotation of the femoral and tibial components between the 2 groups, and none of the clinical scores differed between the groups. Interestingly, in the group with cemented stems, 5 tibia implants showed >1 mm/degree micromotion compared to none in the hybrid group. CONCLUSION There was no difference in median micromotion and clinical outcome between fully cemented and hybrid-placed revision TKA 6.5 years postoperatively. Two femur components showed progressive migration over time whereas tibia components migrate especially in the first year followed by a stable situation. Whether this will lead to loosening and re-revisions remains to be investigated.
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Conlisk N, Howie CR, Pankaj P. An efficient method to capture the impact of total knee replacement on a variety of simulated patient types: A finite element study. Med Eng Phys 2016; 38:959-68. [PMID: 27387906 DOI: 10.1016/j.medengphy.2016.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/08/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
Osteoporosis resulting in a reduction in bone stiffness and thinning of the cortex is almost universal in older patients. In this study a novel method to generate computational models of the distal femur which incorporate the effects of ageing and endosteal trabecularisation are presented. Application of this method to pre- and post-knee arthroplasty scenarios is then considered. These computational methods are found to provide a simple yet effective tool for assessing the post-arthroplasty mechanical environment in the knee for different patient types and can help evaluate vulnerability to supracondylar periprosthetic fracture following implantation. Our results show that the stresses in the periprosthetic region increase dramatically with ageing; this is particularly true for higher flexion angles. Stresses in the anterior region of the femoral cortex were also found to increase significantly post-implantation. The most dramatic increases in stresses and strains at these locations were observed in old osteoporotic patients, explaining why this patient group in particular is at greater risk of periprosthetic fractures.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; School of Engineering, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Howie
- Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, UK
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Zdero R, Saidi K, Mason SA, Schemitsch EH, Naudie DDR. A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements. Proc Inst Mech Eng H 2013. [PMID: 23185955 DOI: 10.1177/0954411912453246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few biomechanical studies exist on femoral cementless press-fit stems for revision total knee replacement (TKR) surgeries. The aim of this study was to compare the mechanical quality of the femur-stem interface for a series of commercially available press-fit stems, because this interface may be a 'weak link' which could fail earlier than the femur-TKR bond itself. Also, the femur-stem interface may become particularly critical if distal femur bone degeneration, which may necessitate or follow revision TKR, ever weakens the femur-TKR bond itself. The authors implanted five synthetic femurs each with a Sigma Short Stem (SSS), Sigma Long Stem (SLS), Genesis II Short Stem (GSS), or Genesis II Long Stem (GLS). Axial stiffness, lateral stiffness, 'offset load' torsional stiffness, and 'offset load' torsional strength were measured with a mechanical testing system using displacement control. Axial (range = 1047-1461 N/mm, p = 0.106), lateral (range = 415-462 N/mm, p = 0.297), and torsional (range = 115-139 N/mm, p > 0.055) stiffnesses were not different between groups. The SSS had higher torsional strength (863 N) than the other stems (range = 167-197 N, p < 0.001). Torsional failure occurred by femoral 'spin' around the stem's long axis. There was poor linear correlation between the femur-stem interface area versus axial stiffness (R = 0.38) and torsional stiffness (R = 0.38), and there was a moderate linear correlation versus torsional strength (R = 0.55). Yet, there was a high inverse linear correlation between interfacial surface area versus lateral stiffness (R = 0.79), although this did not result in a statistical difference between stem groups (p = 0.297). These press-fit stems provide equivalent stability, except that the SSS has greater torsional strength.
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Affiliation(s)
- Radovan Zdero
- Biomechanics Lab, St. Michael's Hospital, Toronto, ON, Canada
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Stilling M, Mechlenburg I, Amstrup A, Soballe K, Klebe T. Precision of novel radiological methods in relation to resurfacing humeral head implants: assessment by radiostereometric analysis, DXA, and geometrical analysis. Arch Orthop Trauma Surg 2012; 132:1521-30. [PMID: 22773108 DOI: 10.1007/s00402-012-1580-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Resurfacing humeral head implants (RHHI) are used to preserve bone stock and restore normal anatomy in the osteoarthritic shoulder joint. The purpose of this study was: (1) to describe the use of novel radiological methods in relation to evaluation of RHHI; (2) to estimate the precision of these methods; and (3) to present preliminary clinical and radiological results at 6 months follow-up after Copeland and Global Cap RHHI. METHODS Twenty-one patients (10 females) at a mean age of 64 (39-82) years and with shoulder osteoarthritis were randomized to a Copeland (n = 11) or Global C.A.P (n = 10) RHHI. Migration of the RHHI was analyzed with radiostereometric analysis (RSA), and bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA). The length of gleno-humeral offset (LGHO) was measured on radiographs. The patients were followed clinically with questionnaires. RESULTS Precision of the radiological methods was high for the LGHO and acceptable for RSA and for DXA. At 6 months, shoulder function had improved significantly for both RHHI groups. LGHO increased significantly for the Copeland RHHI and was slightly reduced for the Global C.A.P. RHHI. The implant migration and BMD change around the implant from baseline until 6 months follow-up was comparable for both RHHI. CONCLUSION Radiostereometric analysis and DXA can be used for evaluation of RHHI, but expectedly with a lower precision as compared to standards of TKA or THA. Geometric analysis of the prosthetic shoulder is precise. We interpret that the early radiological and clinical results of the two RHHI are comparable.
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Affiliation(s)
- Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10 A, Office 13, 8000, Aarhus, Denmark
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Conlisk N, Gray H, Pankaj P, Howie CR. The influence of stem length and fixation on initial femoral component stability in revision total knee replacement. Bone Joint Res 2012; 1:281-8. [PMID: 23610659 PMCID: PMC3626202 DOI: 10.1302/2046-3758.111.2000107] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 10/04/2012] [Indexed: 11/16/2022] Open
Abstract
Objectives Orthopaedic surgeons use stems in revision knee surgery to obtain
stability when metaphyseal bone is missing. No consensus exists
regarding stem size or method of fixation. This in vitro study
investigated the influence of stem length and method of fixation
on the pattern and level of relative motion at the bone–implant
interface at a range of functional flexion angles. Methods A custom test rig using differential variable reluctance transducers
(DVRTs) was developed to record all translational and rotational
motions at the bone–implant interface. Composite femurs were used.
These were secured to permit variation in flexion angle from 0°
to 90°. Cyclic loads were applied through a tibial component based
on three peaks corresponding to 0°, 10° and 20° flexion from a normal
walking cycle. Three different femoral components were investigated
in this study for cementless and cemented interface conditions. Results Relative motions were found to increase with flexion angle. Stemmed
implants reduced relative motions in comparison to stemless implants
for uncemented constructs. Relative motions for cemented implants
were reduced to one-third of their equivalent uncemented constructs. Conclusions Stems are not necessary for cemented implants when the metaphyseal
bone is intact. Short cemented femoral stems confer as much stability
as long uncemented stems.
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Affiliation(s)
- N Conlisk
- The University of Edinburgh, School of Engineering, King's Buildings, Edinburgh EH9 3JL, UK
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Jensen CL, Petersen MM, Schrøder HM, Lund B. Changes in bone mineral density of the distal femur after revision total knee arthroplasty with metaphyseal press-fit stem. J Orthop Traumatol 2010; 11:143-8. [PMID: 20632065 PMCID: PMC2948126 DOI: 10.1007/s10195-010-0098-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 06/28/2010] [Indexed: 11/30/2022] Open
Abstract
Background The effect of postoperative adaptive bone remodeling following a stemmed femoral implant in revision total knee arthroplasty (rTKA) is unknown. The aim of this study was to evaluate bone mineral density (BMD) changes of the distal femur following cemented rTKA with a 100-mm press-fit stem. Materials and methods Sixteen consecutive patients were included in the study (age range 40–85 years; mean 63.5 years). NexGen® (Zimmer, Warsaw, IN, USA) cemented revision implants were used. All implants had the same press-fit femoral stem length of 100 mm. Clinical examinations with evaluation of the knee function using the Knee Society’s Knee Scoring System were used. Measurements of BMD (g/cm2) were performed by dual-energy X-ray absorptiometry (DEXA) using a Norland XR-46 (Norland Corp. Fort Atkinson, WI, USA) bone densitometer. Results Knee and function scores improved significantly (P = 0.005) from the preoperative values to 1 year of follow-up. In regions of interest (ROI) 1–4, a significant increase in BMD (3.5–6.0%) after 6 months was seen. This increase only remained significant in ROI 4 (4.0%, P = 0.01) at 1 year of follow-up. Conclusions The increase in BMD is probably the result of increased mobility and load on the extremity after implantation of a well-functioning rTKA.
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Affiliation(s)
- Claus L Jensen
- Department of Orthopaedic Surgery U, University of Copenhagen, Rigshospitalet, 2100 København Ø, Denmark.
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Meijerink HJ, van Loon CJM, de Waal Malefijt MC, van Kampen A, Verdonschot N. A sliding stem in revision total knee arthroplasty provides stability and reduces stress shielding. Acta Orthop 2010; 81:337-43. [PMID: 20450422 PMCID: PMC2876836 DOI: 10.3109/17453674.2010.483991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE In the reconstruction of unicondylar femoral bone defects with morselized bone grafts in revision total knee arthroplasty, a stem extension appears to be critical to obtain adequate mechanical stability. Whether stability is still assured by this reconstruction technique in bicondylar defects has not been assessed. The disadvantage of relatively stiff stem extensions is that bone resorption is promoted due to stress shielding. We therefore designed a stem that would permit axial sliding movements of the articulating part relative to the intramedullary stem. METHODS This stem was used in the reconstruction with impaction bone grafting (IBG) of 5 synthetic distal femora with a bicondylar defect. A cyclically axial load was applied to the prosthetic condyles to assess the stability of the reconstruction. Radiostereometry was used to determine the migrations of the femoral component with a rigidly connected stem, a sliding stem, and no stem extension. RESULTS We found a stable reconstruction of the bicondylar femoral defects with IBG in the case of a rigidly connected stem. After disconnecting the stem, the femoral component showed substantially more migrations. With a sliding stem, rotational migrations were similar to those of a rigidly connected stem. However, the sliding stem allowed proximal migration of the condylar component, thereby compressing the IBG. INTERPRETATION The presence of a functional stem extension is important for the stability of a bicondylar reconstruction. A sliding stem provides adequate stability, while stress shielding is reduced because compressive contact forces are still transmitted to the distal femoral bone.
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Affiliation(s)
- Huub J Meijerink
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen
| | | | | | - Albert van Kampen
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen
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The effect of 6 months oral alendronate treatment on periprosthetic bone loss after total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2008. [DOI: 10.1007/s00590-008-0412-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. ACTA ACUST UNITED AC 2008; 89:1457-61. [PMID: 17998181 DOI: 10.1302/0301-620x.89b11.19840] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have examined the results obtained with 72 NexGen legacy posterior stabilised-flex fixed total knee replacements in 47 patients implanted by a single surgeon between March 2003 and September 2004. Aseptic loosening of the femoral component was found in 27 (38%) of the replacements at a mean follow-up of 32 months (30 to 48) and 15 knees (21%) required revision at a mean of 23 months (11 to 45). We compared the radiologically-loose and revised knees with those which had remained well-fixed to identify the factors which had contributed to this high rate of aseptic loosening. Post-operatively, the mean maximum flexion was 136 degrees (110 degrees to 140 degrees) in the loosened group and 125 degrees (95 degrees to 140 degrees) in the well-fixed group (independent t-test, p = 0.022). Squatting, kneeling, or sitting cross-legged could be achieved by 23 (85%) of the loosened knees, but only 22 (49%) of the well-fixed knees (chi-squared test, p = 0.001). The loosened femoral components were found to migrate into a more flexed position, but no migration was detected in the well-fixed group. These implants allowed a high degree of flexion, but showed a marked rate of early loosening of the femoral component, which was associated with weight-bearing in maximum flexion.
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Affiliation(s)
- H S Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Dongjak-gu, 156-707 Seoul, Korea
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Shi JF, Wang CJ, Laoui T, Hart W, Hall R. A dynamic model of simulating stress distribution in the distal femur after total knee replacement. Proc Inst Mech Eng H 2007; 221:903-12. [PMID: 18161250 DOI: 10.1243/09544119jeim256] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study has been to develop a dynamic model of the knee joint after total knee replacement (TKR) to analyse the stress distribution in the distal femur during daily activities. Using MSC/ADAMS and MSC/MARC software, a dynamic model of an implanted knee joint has been developed. This model consists of the components of the knee prosthesis as well as the bones and ligaments of the knee. The femur, tibia, fibula, and patella have been modelled as mixed cortico-cancellous bone. The distal part of femur has been modelled as a flexible body with springs used to simulate the ligaments positioned at their anatomical insertion points. With this dynamic model a gait cycle was simulated. Stress shielding was identified in the distal femur after TKR, which is consistent with other investigators' results. Interestingly, higher stresses were found in the bone adjacent to the femoral component peg. This dynamic model can now be used to analyse the stress distribution in the distal femur with different load conditions. This will help to improve implant designs and will allow comparison of prostheses from different manufacturers.
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Affiliation(s)
- J F Shi
- Department of Engineering and Technology, University of Wolverhampton, Telford, UK
| | - C J Wang
- Department of Engineering and Technology, University of Wolverhampton, Telford, UK
| | - T Laoui
- Department of Engineering and Technology, University of Wolverhampton, Telford, UK
| | - W Hart
- New Cross Hospital, Wolverhampton, UK
| | - R Hall
- Department of Engineering and Technology, University of Wolverhampton, Telford, UK
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Barrack RL, Stanley T, Burt M, Hopkins S. The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty 2004; 19:119-24. [PMID: 15457430 DOI: 10.1016/j.arth.2004.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A series of 143 revision total knee arthroplasties was evaluated using a Knee Society clinical score, radiographic assessment, and satisfaction questionnaire. Patients completed a pain drawing showing the location and severity of pain they experienced at 2 years follow-up. Two stem designs were used: a solid, fluted cobalt chrome stem (group I) and a slotted titanium stem (group II). End-of-stem pain was associated with solid cobalt chrome stems while a lower incidence of stem pain was associated with slotted titanium stems. Symptoms were intermittent and activity related in all but 2 cases, but none required component revision. The presence of end-of-stem pain did appear to be clinically significant because patients with this pain were more likely to be only somewhat satisfied or dissatisfied with their degree of pain relief compared to those without end-of-stem pain. Stem design does appear to impact the incidence of end-of-stem pain in revision total knee arthroplasty.
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Affiliation(s)
- Robert L Barrack
- Tulane University Health Sciences Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
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