Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty

Abstract

Background: Articular surface curvature design is important in tibiofemoral kinematics and the contact mechanics of total knee arthroplasty (TKA). Thus far, the effects of articular surface curvature have not been adequately discussed with respect to conforming, nonconforming, and medial pivot designs in patient-specific TKA. Therefore, this study evaluates the underlying relationship between the articular surface curvature geometry and the wear performance in patient-specific TKA. Methods: We compare the wear performances between conventional and patient-specific TKA under gait loading conditions using a computational simulation. Patient-specific TKAs investigated in the study are categorized into patientspecific TKA with conforming articular surfaces, medial pivot patient-specific TKA, and bio-mimetic patient-specific TKA with a patient's own tibial and femoral anatomy. The geometries of the femoral components in patient-specific TKAs are identical. Results: The anterior-posterior and internal-external kinematics change with respect to different TKA designs. Moreover, the contact pressure and area did not directly affect the wear performance. In particular, conforming patient-specific TKAs exhibit the highest volumetric wear and wear rate. The volumetric wear in a conforming patient-specific TKA is 29% greater than that in a medial pivot patient-specific TKA. Conclusion: The findings in this study highlight that conformity changes in the femoral and tibial inserts influence the wear performance in patient-specific TKA. Kinematics and contact parameters should be considered to improve wear performance in patient-specific TKA. The conformity modification in the tibiofemoral joint changes the kinematics and contact parameters, and this affects wear performance.

Biomechanical and Clinical Effect of Patient-Specific or Customized Knee Implants: A Review

“…This trend was also found in CR patient-specific TKA [100]. A previous study showed that conformity changes in the femoral and tibial inserts influence the wear performance in CR patient-specific TKA [100].…”

“…This trend was also found in CR patient-specific TKA [100]. A previous study showed that conformity changes in the femoral and tibial inserts influence the wear performance in CR patient-specific TKA [100]. Kinematics and contact parameters should be considered to improve wear performance in CR patient-specific TKA [100].…”

“…A previous study showed that conformity changes in the femoral and tibial inserts influence the wear performance in CR patient-specific TKA [100]. Kinematics and contact parameters should be considered to improve wear performance in CR patient-specific TKA [100]. The conformity modification in the tibiofemoral joint changes the kinematics, contact parameters, and wear performance [100].…”

“…Kinematics and contact parameters should be considered to improve wear performance in CR patient-specific TKA [100]. The conformity modification in the tibiofemoral joint changes the kinematics, contact parameters, and wear performance [100]. However, anatomy-mimetic CR patient-specific TKA did not show the best wear performance.…”

Mechanical alignment tolerance of a cruciate-retaining knee prosthesis under gait loading—A finite element analysis

“…Previous studies have shown that component alignment affects the kinematics of the knee joint, including the femoral anteroposterior translation and tibial rotation ( Shih et al, 2020 ; Wang et al, 2021 ; Fang et al, 2022 ). Malignment can also produce higher stress and contact pressure on the tibial insert, which may increase wear and lead to premature failure ( Rostoker and Galante, 1979 ; Liau et al, 1999 ; Liau et al, 2002 ; Cheng et al, 2003 ; Koh et al, 2020 ). Therefore, it is not sufficient to only assess the standard alignment position during pre-clinical testing, various alignments based on clinical feedback should be evaluated, with consideration also given to increasing the alignment tolerance.…”