Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Innocenti, Bernardo; Fekete, Gusztáv; Pianigiani, Silvia

doi:10.1115/1.4040966

Cited by 29 publications

(53 citation statements)

References 49 publications

(116 reference statements)

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“…Thus, the TO technique was incorporated with porous architecture in this study. Porous architecture has been wildly used in orthopedics as it could effectively reduce stiffness ( Ryan et al, 2006 ; Innocenti et al, 2018 ; Peto et al, 2019 ). Wang et al designed a hip implant with three-dimensional (3D) porous architecture to reduce stress shielding and prevent implant micromotion ( Wang et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Design of Porous Metal Block Augmentation to Treat Tibial Bone Defects in Total Knee Arthroplasty Based on Topology Optimization

Liu

Chen

Wang

et al. 2021

Front. Bioeng. Biotechnol.

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Metal block augmentation, which is used for the treatment of tibial bone defects in total knee arthroplasty, with high stiffness will cause significant alteration in stress distribution, and its solid structure is not suitable for osseointegration. This study aimed to design a porous block to reduce weight, promote bone ingrowth, and improve its biomechanical performance. The metal block augmentation technique was applied to finite element models of tibial bone defects. Minimum compliance topology optimization subject to volume fraction combined with the porous architecture was adopted to redesign the block. Biomechanical changes compared with the original block were analyzed by finite element analysis. The stress distribution of the block and proximal tibia was recorded. The strain energy density of the proximal tibia was obtained. The newly designed block realized 40% weight reduction. The maximum stress in the optimized block decreased by 11.6% when compared with the solid one. The maximum stress of the proximal tibia in the optimized group increased by 18.6%. The stress of the anterior, medial, and posterior parts of the proximal medial tibia in the optimized group was significantly greater than that in the original group (all p < 0.05). The optimized block could effectively improve the biomechanical performance between the block and the bone. The presented method might provide a reference for the design of customized three-dimensional printed prostheses.

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Section: Introductionmentioning

confidence: 99%

Design of Porous Metal Block Augmentation to Treat Tibial Bone Defects in Total Knee Arthroplasty Based on Topology Optimization

Liu

Chen

Wang

et al. 2021

Front. Bioeng. Biotechnol.

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“…Indeed, the presence of a wedge is a fundamental tool to treat bone defect, because, if it is untreated, it could lead to a missing mechanical support producing high bone stress variation. However, as determined by Innocenti [11], among the different augment options, the main parameter that is responsible for the change of bone stress is the material (due to its stiffness) of the augment that should be as close as possible to the one of the bone. Moreover, due to the additional benefit of the porous metal of allowing bone ingrowth, the loosening rate will be further reduced.…”

Section: Discussionmentioning

confidence: 99%

A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

Burastero¹,

Cavagnaro²,

Chiarlone³

et al. 2018

TOORTHJ

Self Cite

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Background: Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction. Objective: The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery. Methods: We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device. Results: To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings. Conclusion: In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

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“…Most of the augmentations are made of solid titanium 6 aluminum 4 vanadium alloy with a blasted surface. The thickness of the blocks is usually increased by 5 mm, and the total thickness generally does not exceed 15 mm because a block thicker than 20 mm has difficulty offloading the shearing force concentrated at the stem extension ( 56 ).…”

Section: Design and Rationale Of Prostheses In Rtkamentioning

confidence: 99%

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

Zhang

2022

EFORT Open Reviews

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The number of primary and revision total knee arthroplasties (rTKAs) continues to increase annually. To date, most of the literature has focused on the surgical technique and outcome of revision prostheses. Thanks to the contributions of surgeons, engineers, and researchers, the design of prostheses has reached a prominent milestone. However, very limited discussion regarding the design, rationale and constitution of prostheses has been documented at present. An electronic search of four online databases (Embase, MEDLINE, PubMed, and Google Scholar) was conducted to identify eligible resources. Forty-four review articles were acquired by searching the terms ‘prosthesis selection’, ‘prosthesis option’, and ‘prosthesis determination’ in rTKA. Sixty-eight research articles investigating the factors affecting prosthesis options in rTKA were screened and integrated with the authors’ perspective to reach a final recommendation. This article first discusses the pathological, individual, and other factors affecting prosthesis options in rTKA and further illustrates the classification, geometry, biomechanics, and constitution of the revision system from the authors’ perspective. An evidence-based recommendation in the form of a matching algorithm was formulated. This review offers special value for decision-making regarding prosthesis options in rTKA. Particularly, it presents specific recommendations regarding unclear practical issues, such as the optimal level of constraint, individualized design, length, and fixation of extension stem, as well as the pros and cons of modularity.

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Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Cited by 29 publications

References 49 publications

Design of Porous Metal Block Augmentation to Treat Tibial Bone Defects in Total Knee Arthroplasty Based on Topology Optimization

Design of Porous Metal Block Augmentation to Treat Tibial Bone Defects in Total Knee Arthroplasty Based on Topology Optimization

A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

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