The Effect of Rotating Platform TKA on Strain Distribution and Torque Transmission on the Proximal Tibia

Malinzak, Robert A.; Small, Scott R.; Rogge, Renee; Archer, Derek B.; Oja, Jordan W; Berend, Michael E.; Ritter, Merrill A.

doi:10.1016/j.arth.2013.08.024

Cited by 26 publications

(15 citation statements)

References 39 publications

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“…Malinzak et al 49 reached the same conclusion in their in vitro study with RP and FB primary and revision PFC/Sigma knees (DePuy Synthes). In the RP variants, transmitted torque under compressive loading conditions was lessened significantly, which resulted in significantly reduced cortical strains around the entire periphery of the proximal tibial cortex.…”

Section: Kinetics: Does Load Sharing Lead To Reduced Loosening Stress?mentioning

confidence: 58%

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Zürcher¹,

Stiehl²,

Pöll³

2016

Orthopedics

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Low-contact-stress mobile-bearing (MB) total knee arthroplasty (TKA) can rely on a long history. Its concept comprises a combination of high condylar congruency and compensatory bearing rotation to promote load sharing. However, other MB designs have become available, and critical points have been raised about the benefit of MB in general. Although there is kinematic and kinetic support for the low-contact-stress concept, there is no tribologic or clinical proof of its superiority over fixed-bearing concepts. Further study should be controlled for differences in polyethylene quality and need to provide a measure of condylar congruency to differentiate authentic low-contact-stress variants form others. [Orthopedics. 2016; 39(3):e402-e412.].

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Section: Kinetics: Does Load Sharing Lead To Reduced Loosening Stress?mentioning

confidence: 58%

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Zürcher¹,

Stiehl²,

Pöll³

2016

Orthopedics

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“…Importantly, this study has presented a selection process for the key DIC analysis parameters, which govern the reliability of implanted bone strain measurement. Previous knee implant studies using DIC to assess bone strain have focused on the tibial bone surface [ 14 , 15 , 20 ]. A DIC study on periprosthetic bone strains with postmortem retrieved TKA tibial components carried out by Mann et al [ 15 ] suggested that a reduction in BMD leads to higher bone strains, which could lead to an increased risk of failure.…”

Section: Discussionmentioning

confidence: 99%

Does a PEEK Femoral TKA Implant Preserve Intact Femoral Surface Strains Compared With CoCr? A Preliminary Laboratory Study

Rankin

Dickinson

Briscoe³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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BackgroundBoth the material and geometry of a total knee arthroplasty (TKA) component influence the induced periprosthetic bone strain field. Strain, a measure of the local relative deformation in a structure, corresponds to the mechanical stimulus that governs bone remodeling and is therefore a useful in vitro biomechanical measure for assessing the response of bone to new implant designs and materials. A polyetheretherketone (PEEK) femoral implant has the potential to promote bone strains closer to that of natural bone as a result of its low elastic modulus compared with cobalt-chromium (CoCr).Questions/purposesIn the present study, we used a Digital Image Correlation (DIC) technique to answer the following question: Does a PEEK TKA femoral component induce a more physiologically normal bone strain distribution than a CoCr component? To achieve this, a DIC test protocol was developed for periprosthetic bone strain assessment using an analog model; the protocol aimed to minimize errors in strain assessment through the selection of appropriate analysis parameters.MethodsThree synthetic bone femurs were used in this experiment. One was implanted with a CoCr femoral component and one with a PEEK femoral component. The third (unimplanted) femur was intact and used as the physiological reference (control) model. All models were subjected to standing loads on the corresponding polyethylene (ultrahigh-molecular-weight polyethylene) tibial component, and speckle image data were acquired for surface strain analysis using DIC in six repeat tests. The strain in 16 regions of interest on the lateral surface of each of the implanted bone models was plotted for comparison with the corresponding strains in the intact case. A Wilcoxon signed-rank test was used to test for difference at the 5% significance level.ResultsSurface analog bone strain after CoCr implantation indicated strain shielding (R2 = 0.6178 with slope, β = 0.4314) and was lower than the intact case (p = 0.014). The strain after implantation with the PEEK implant deviated less from the intact case (R2 = 0.7972 with slope β = 0.939) with no difference (p = 0.231).ConclusionsThe strain shielding observed with the contemporary CoCr implant, consistent with clinical bone mineral density change data reported by others, may be reduced by using a PEEK implant.Clinical RelevanceThis bone analog in vitro study suggests that a PEEK femoral component could transfer more physiologically normal bone strains with a potentially reduced stress shielding effect, which may improve long-term bone preservation. Additional studies including paired cadaver tests are necessary to test the hypothesis further.

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“…Fixed bearing designs exhibit greater torque and higher cortical strain than rotating platform designs [22]. If there is an influence using the rotating platform on rotational laxity, it has not been studied so far [23].…”

Section: Discussionmentioning

confidence: 99%

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

Mayr

Reinhold²,

Hube³

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate laxity in knees with pre-operative (preop) valgus alignment compared to knees with pre-operative varus alignment after total knee arthroplasty (TKA). Methods This was a retrospective study including 81 patients, with six years follow-up, for pre-operative valgus-or varus alignment of the leg. All patients had been supplied with the same cruciate retaining (CR) TKA with rotating platform. Clinical findings were assessed by KSS, OKS and IKDC 2000 score. Rotational knee laxity was evaluated by a validated instrument (Laxitester®) with 2 Nm torque in 30°flex-ion. Collateral ligament laxity was tested manually in 30°f lexion with a bending moment of approximately5 Nm. Biomechanical results were compared to the contralateral side. Results Thirty-one patients had a preop valgus alignment of 8.96°and 50 patients a varus leg axis of 4.99°in the mean. In the preop valgus knees rotational analysis showed an increased laxity of 10.7°compared to preop varus knees (p=0.001). There was no significant difference in medial (valgus 2.6 mm, varus 2.5 mm) and lateral (valgus 2.8 mm, varus 2.7 mm) laxity. KSS and OKS showed no significant differences in the follow-up results. In the IKDC 2000 objective score 50 % of the preop varus knees and 25.8 % of the preop valgus knees were classified as nearly normal. The difference in the IKDC objective was highly significant (p<0.001). Conclusion Preop valgus knees show a significantly increased rotational laxity but no increased collateral ligament laxity compared to pre-operative varus knees six years after TKA with rotating platform. There is a significant difference in IKDC objective.

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The Effect of Rotating Platform TKA on Strain Distribution and Torque Transmission on the Proximal Tibia

Cited by 26 publications

References 39 publications

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Does a PEEK Femoral TKA Implant Preserve Intact Femoral Surface Strains Compared With CoCr? A Preliminary Laboratory Study

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

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