Load Sharing and Ligament Strains in Balanced, Overstuffed and Understuffed UKA. A Validated Finite Element Analysis

Innocenti, Bernardo; Bilgen, Ömer Faruk; Labey, Luc; Lenthe, G. Harry van; Sloten, Jos Vander; Catani, Fabio

doi:10.1016/j.arth.2014.01.020

Cited by 74 publications

(107 citation statements)

References 54 publications

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“…The comprehensive tibial component was then coupled to the corresponding femoral component considering an interaction friction coefficient of 0.1 to simulate the effect of synovial liquid. 8 A linear, elastic and isotropic material model was considered for all the materials used in this study [9][10][11] ; the material properties are detailed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

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Investigation on the Effects Induced by Tka Features on Tibio-Femoral Mechanics Part I: Femoral Component Designs

Innocenti

Yagüe

Bernabé

et al. 2015

J. Mech. Med. Biol.

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The lack of awareness of the exact number of instantaneous centers of knee flexion/extension rotation leads to the presence in the market of total knee arthroplasty (TKA) femoral components designed under different hypotheses. Although single radius (SR) designs are thought to replicate the physiological behavior in a more realistic way, surgeons do not always agree about the veracity of their theoretical advantages with respect to the multiple radii components (J-curve (JC) design). Apart from clinical studies, up to now, any literature study biomechanically and exhaustively compares these two TKA solutions, thus a finite element analysis (FEA) has been carried out. In particular, two models were defined to analyze the performance of a SR design and a JC design with the same tibial component during gait cycle and squat motor task. Tibio-femoral kinematics and kinetics have been investigated comparing the resulting contact area between components, internal-external (IE) rotation, position and magnitude of the center of total forces due to contact pressure and polyethylene von Misses stresses. Results demonstrate that, for low demanding tasks, there are no significant differences between the two designs, however, during the squat motor task, some changes in contact force and increases in polyethylene stress were identified for the SR solution.

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Section: Methodsmentioning

confidence: 99%

“…The boundary conditions of the squat movement, in terms of flexion-extension angle (up to 120 ) and axial force, were taken accordingly to previously experimental activities, 9,13 while the other degrees of freedom were kept free.…”

Section: Methodsmentioning

confidence: 99%

Investigation on the Effects Induced by Tka Features on Tibio-Femoral Mechanics Part I: Femoral Component Designs

Innocenti

Yagüe

Bernabé

et al. 2015

J. Mech. Med. Biol.

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“…17 Innocenti et al studied the balanced load-sharing and ligament strains in overand under-stuffed UKA using an FE model with soft tissue structures. 18 To our knowledge, the joint line preservation, especially its biomechanical effects in UKA, have not been reported. In the present study, we develop validated FE model of UKA and evaluate the contact stress on the PE insert, tibial cartilage, and lateral meniscus, induced by post-operative change of the joint line.…”

mentioning

confidence: 88%

“…Kwon et al primarily included bony and soft tissue structures in an FE model for UKA and evaluated the effects of fixed‐ and mobile‐bearing UKA on the lateral meniscus under gait cycle loading conditions . Innocenti et al studied the balanced load‐sharing and ligament strains in over‐ and under‐stuffed UKA using an FE model with soft tissue structures …”

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confidence: 99%

Importance of joint line preservation in unicompartmental knee arthroplasty: Finite element analysis

Kwon

Kang

Son

et al. 2016

Journal Orthopaedic Research

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Unicompartmental knee arthroplasty (UKA) is an effective surgical technique for pain relief and functional restoration in patients with localized osteoarthritis of the knee joint. However, the role of the joint line in UKA, especially its biomechanical effect, has not been previously investigated. This study numerically evaluates the effects of the joint line on the contact stresses in polyethylene (PE) inserts, articular cartilage, and lateral meniscus using the finite element (FE) analysis. The FE model for joint line was modeled as the orthogonal projection line from the medial tibial plateau to the anatomical axis. The joint line was varied from -6 to +6 mm in 2 mm intervals, and the seven FE models were analyzed and compared under ISO gait loading conditions. The contact stresses in the PE insert, articular cartilage, and lateral meniscus matched those of the reference joint line (0 mm) in the ±2 and ±4 mm joint line cases but significantly differed from the reference in the ±6 mm joint line cases. On the +6 mm joint line, the contact stress was greater on the PE insert than on the articular cartilage, whereas the reverse occurred on the -6 mm joint line. This study confirms the post-operative significance of joint line preservation in UKA implantation surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:347-352, 2017.

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“…However, the effect of adjusting tibial insert thickness on the biomechanical function of the knee, specifically the forces carried by the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL), and the resulting kinematics through a range of flexion, are not well understood. A previous biomechanical study of UKA that integrated cadaveric testing and computational modeling reported the effect of adjusting tibial insert thickness on ligament strain and contact stress at full extension, but the interaction between tibiofemoral kinematics and ligament forces through a range of flexion was not described. Previous studies have reported that increasing the thickness of the polyethylene (PE) tibial insert lengthens the distance between the attachments of the superficial MCL during simulated activities in a cadaver model .…”

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confidence: 99%

Fixed‐bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion

Kia

Warth

Lipman

et al. 2018

Journal Orthopaedic Research

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Medial unicompartmental knee arthroplasty (UKA) is an accepted treatment for isolated medial osteoarthritis. However, using an improper thickness for the tibial component may contribute to early failure of the prosthesis or disease progression in the unreplaced lateral compartment. Little is known of the effect of insert thickness on both knee kinematics and ligament forces. Therefore, a computational model of the tibiofemoral joint was used to determine how non-conforming, fixed bearing medial UKA affects tibiofemoral kinematics, and tension in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) during passive knee flexion. Fixed bearing medial UKA could not maintain the medial pivoting that occurred in the intact knee from 0° to 30° of passive flexion. Abnormal anterior-posterior (AP) translations of the femoral condyles relative to the tibia delayed coupled internal tibial rotation, which occurred in the intact knee from 0° to 30° of flexion, but occurred from 30° to 90° of flexion following UKA. Increasing or decreasing tibial insert thickness following medial UKA also failed to restore the medial pivoting behavior of the intact knee despite modulating MCL and ACL forces. Reduced AP constraint in non-conforming medial UKA relative to the intact knee leads to abnormal condylar translations regardless of insert thickness even with intact cruciate and collateral ligaments. This finding suggests that the conformity of the medial compartment as driven by the medial meniscus and articular morphology plays an important role in controlling AP condylar translations in the intact tibiofemoral joint during passive flexion. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1868-1875, 2018.

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Load Sharing and Ligament Strains in Balanced, Overstuffed and Understuffed UKA. A Validated Finite Element Analysis

Cited by 74 publications

References 54 publications

Investigation on the Effects Induced by Tka Features on Tibio-Femoral Mechanics Part I: Femoral Component Designs

Investigation on the Effects Induced by Tka Features on Tibio-Femoral Mechanics Part I: Femoral Component Designs

Importance of joint line preservation in unicompartmental knee arthroplasty: Finite element analysis

Fixed‐bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion

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