All-polyethylene tibial components generate higher stress and micromotions than metal-backed tibial components in total knee arthroplasty

Brihault, Jean; Navacchia, Alessandro; Pianigiani, Silvia; Labey, Luc; Corte, Ronny De; Pascale, Valerio; Innocenti, Bernardo

doi:10.1007/s00167-015-3630-8

Cited by 38 publications

(36 citation statements)

References 44 publications

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“…Moreover, as this study does not aim to microscopically analyze the bone-implant interface, the porosity of the cancellous bone was not implemented in the model. Under these hypotheses, and according to literature [25,27,[36][37][38], the cortical bone was considered transversely isotropic and the following materials properties were used:…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Innocenti

Fekete

Pianigiani

2018

Journal of Biomechanical Engineering

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Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.

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Section: Introductionmentioning

confidence: 99%

“…Similar to previous studies, the behavior of the ligaments was assumed linear elastic isotropic [25,29,30,36,37]. Each ligament was modeled as a beam with a specific cross-sectional area [29][30][31]36].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Innocenti

Fekete

Pianigiani

2018

Journal of Biomechanical Engineering

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“…Firstly, lighter materials with the same size and volume of the knee joint prosthesis should be used. Polyethylene tibial components prosthesis has been applied to clinical practice, which can significantly reduce the weight of the prosthesis on the tibial plateau, but some studies have shown that all-polyethylene prosthesis is poor in hardness and may generate higher stress and micromotions than metal-backed tibial components [18]. Secondly, the volume of the non-load-bearing part of the prosthesis should be reduced.…”

Section: Discussionmentioning

confidence: 99%

Excised host tissues weight: New Indicators of Total Knee Arthroplasty Worthy of Attention

Zhu¹,

Ruan²,

Bai³

et al. 2020

Preprint

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Background: Knee osteoarthritis (KOA) is a crippling disease and affects many people around the world. Total knee arthroplasty (TKA) is an effective way to treat this disease. The objectaives of this study to compare the weight of the total knee arthroplasty implants and the weight of the natural knee in different groups and also to analyze facts which may affect the weight of surgical host excision. Methods: In total, 105 consecutive TKAs were enrolled in this prospective cohort study with three different brands of knee prostheses. Patients meeting the criterion were divided into the normal bone mass group, the osteopenia group or the osteoporosis group according to the results of preoperative bone density examination. The removal of bone and soft tissues that were collected during TKA operations of each group were weighed and compared with the total weight of the knee prosthesis (including implanted bone cement). Multivariate logistic stepwise regression analysis was conducted to identify indicators affecting host removal weight.Results: The average host removal weight was (132.56±36.88)g for normal bone mass group, (112.86±23.65)g for osteopenia group and (103.74±20.66)g for osteoporosis group. There were statically differences among the three groups. There was a significant difference between the normal bone mass group and the osteopenia group (P=0.003), while no difference between the osteopenia group and the osteoporosis group (P=0.154). No differences were found in the TKA components weight, bone cement weight and knee joint weight gained after TKA among all groups. Stepwise multiple regression analysis using the weight of excised host tissues as a dependent variable and BMD level, gender, age and other available indicators as independent variables revealed that BMD level(B=9.057, p=0.008), gender(B=21.692, p<0.001), Kellgren-Lawrence grade(B=13.790, p=0.003) are significant factors affecting excised host tissues weight. Conclusion: There is a positive correlation between the weight of the host removals of TKA and the patient's bone density. BMD level, gender and K-L stage of KOA were the main factors affecting the weight of the host removal.

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“…The materials considered in this study were assumed to be homogeneous, isotropic, and linear elastic [36,43,44]; the properties assigned to femoral component, tibial insert, and tibial tray were respectively the ones of cobalt-chromium alloy (CoCr), of ultra-high-molecular-weight polyethylene, and of titanium alloy (Ti6Al4V). According to the literature, the cortical bone was considered transversely isotropic with properties varying along the mechanical axis of the tibia; the cancellous one was instead assumed to be homogeneous, isotropic, and linear [36,37,39,45,46]. The material properties of the knee model used in this study are reported in Table 1.…”

Section: Materials Models and Propertiesmentioning

confidence: 99%

Analysis of Biomechanical Differences Between Condylar Constrained Knee and Rotating Hinged Implants: A Numerical Study

Andreani

Pianigiani

Bori

et al. 2020

The Journal of Arthroplasty

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Background: Different levels of constraint for total knee arthroplasty can be considered for revision surgeries. While prior studies have assessed the clinical impact and patient outcomes of condylar constrained knee (CCK) and rotating hinged (RTH) implants, nowadays little is known about the biomechanical effects induced by different levels of constraint on bone stress and implant micromotions. Methods: CCK and RTH implant models were analyzed using a previously validated numerical model. Each system was investigated during a squat and a lunge motor task. The force in the joint, the bone and implant stresses, and micromotions in this latter were analyzed and compared among designs. Results: Different activities induced similar bone stress distributions in both implants. The RTH implant induces mostly high stress compared to the CCK implant, especially in the region close to tip of the stem. However, in the proximal tibia, the stresses achieved with the CCK implant is higher than the one calculated for the RTH design, due to the presence of the post-cam system. Accordingly, the condylar constrained design shows higher implant micromotions due to the greater torsional constraint. Conclusion: Different levels of constraint in revision arthroplasty were always associated with different biomechanical outputs. RTH implants are characterized by higher tibial stress especially in the region close to the stem tip; condylar implants, instead, increase the proximal tibial stress and therefore implant micromotions, as a result of the presence of the post-cam mechanism. Surgeons will have to consider these findings to guarantee the best outcome for the patient and the related change in the bone stress and implant fixation induced by different levels of constrain in a total knee arthroplasty.

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All-polyethylene tibial components generate higher stress and micromotions than metal-backed tibial components in total knee arthroplasty

Cited by 38 publications

References 44 publications

Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Excised host tissues weight: New Indicators of Total Knee Arthroplasty Worthy of Attention

Analysis of Biomechanical Differences Between Condylar Constrained Knee and Rotating Hinged Implants: A Numerical Study

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