The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty

Stoddart, Jennifer C.; Garner, Amy; Tuncer, Mahmut; Cobb, Justin P.; Arkel, Richard J. van

doi:10.1302/2046-3758.118.bjr-2021-0533.r1

Cited by 6 publications

(7 citation statements)

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“…The monocentric nature of the study with only two implants used was that it may not be possible to extrapolate the results to all patients. The implant dimensions and the influence of positioning on the risk of oversizing or undersizing have not been assessed, which may influence the risk of tibial spine fractures and therefore clinical outcomes [32].…”

Section: Discussionmentioning

confidence: 99%

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Micicoi,

Machado,

Ernat

et al. 2023

Knee surg. sports traumatol. arthrosc.

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PurposeThe alignment obtained after unicompartmental knee arthroplasty (UKA) inluences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the inluence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes. Methods This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre-and postoperatively. Outliers were deined as follows: Δ Cartier > 3° (diference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (diference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre-and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coeicient. Results During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was signiicantly correlated with IKS function (R 2 = 0.06, p < 0.001) and FJS (R 2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was signiicantly correlated (p < 0.001) with KOOS (R 2 = 0.38), IKS Knee (R 2 = 0.17), IKS function (R 2 = 0.34), SKV (R 2 = 0.08), and FJS (R 2 = 0.37) scores. In subgroup analysis, nonoutliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients. Conclusion Functional results after medial UKA can be inluenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be conirmed by other controlled studies. Level of evidence IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Micicoi,

Machado,

Ernat

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…118 Stoddart et al suggested that bi-UKA had a similar risk of tibial eminence avulsion fracture to UKA, with a higher risk of fracture when tibial bone density was lower. 119 To conclude, finite element analysis applied to osteoarthritis and joint replacement can provide strong biomechanical evidence for prosthesis design and placement, as well as predicting the outcome of replacement surgery. Therefore, it has a promising future in clinical research.…”

Section: Osteoarthritismentioning

confidence: 99%

“…Stoddart et al . suggested that bi‐UKA had a similar risk of tibial eminence avulsion fracture to UKA, with a higher risk of fracture when tibial bone density was lower 119 …”

Section: Application and Characteristicsmentioning

confidence: 99%

Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review

Yan,

Liang,

Zhao

et al. 2024

Orthopaedic Surgery

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The knee is the most complex joint in the human body, including bony structures like the femur, tibia, fibula, and patella, and soft tissues like menisci, ligaments, muscles, and tendons. Complex anatomical structures of the knee joint make it difficult to conduct precise biomechanical research and explore the mechanism of movement and injury. The finite element model (FEM), as an important engineering analysis technique, has been widely used in many fields of bioengineering research. The FEM has advantages in the biomechanical analysis of objects with complex structures. Researchers can use this technology to construct a human knee joint model and perform biomechanical analysis on it. At the same time, finite element analysis can effectively evaluate variables such as stress, strain, displacement, and rotation, helping to predict injury mechanisms and optimize surgical techniques, which make up for the shortcomings of traditional biomechanics experimental research. However, few papers introduce what material properties should be selected for each anatomic structure of knee FEM to meet different research purposes. Based on previous finite element studies of the knee joint, this paper summarizes various modeling strategies and applications, serving as a reference for constructing knee joint models and research design.

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“…Frontiers in Bioengineering and Biotechnology frontiersin.org condition, since neither were present in the orthoload data (i.e., ACL and PCL for the native, PKA, and CPKA states and PCL only for the TKA state). 3) In native knee compartments, condylar loads were distributed to simulate the effect of the menisci and cartilage, in accordance with a method that has previously been verified (Stoddart et al, 2022) with lab data (Munford et al, 2022). 4) Loading through implants was applied as point load to the implant, in accordance with the previous model validation (Tuncer et al, 2013).…”

Section: Boundary Conditionsmentioning

confidence: 99%

“…CPKA procedures could, in theory, lead to favorable load transfer to bone, as articulating surfaces, ligaments, and bone stock are preserved compared to TKA. However, it is also possible that the regions of bone between implants could lead to unfavorable loading conditions that could, perhaps, accelerate bone loss (through strain shielding) or risk of fracture (through overstraining) (Stoddart et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Load transfer in bone after partial, multi-compartmental, and total knee arthroplasty

Stoddart,

Garner,

Tuncer

et al. 2024

Front. Bioeng. Biotechnol.

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Introduction: Arthroplasty-associated bone loss remains a clinical problem: stiff metallic implants disrupt load transfer to bone and, hence, its remodeling stimulus. The aim of this research was to analyze how load transfer to bone is affected by different forms of knee arthroplasty: isolated partial knee arthroplasty (PKA), compartmental arthroplasty [combined partial knee arthroplasty (CPKA), two or more PKAs in the same knee], and total knee arthroplasty (TKA).Methods: An experimentally validated subject-specific finite element model was analyzed native and with medial unicondylar, lateral unicondylar, patellofemoral, bi-unicondylar, medial bicompartmental, lateral bicompartmental, tricompartmental, and total knee arthroplasty. Three load cases were simulated for each: gait, stair ascent, and sit-to-stand. Strain shielding and overstraining were calculated from the differences between the native and implanted states.Results: For gait, the TKA femoral component led to mean strain shielding (30%) more than three times higher than that of PKA (4%–7%) and CPKA (5%–8%). Overstraining was predicted in the proximal tibia (TKA 21%; PKA/CPKA 0%–6%). The variance in the distribution for TKA was an order of magnitude greater than for PKA/CPKA, indicating less physiological load transfer. Only the TKA-implanted femur was sensitive to the load case: for stair ascent and gait, almost the entire distal femur was strain-shielded, whereas during sit-to-stand, the posterior femoral condyles were overstrained.Discussion: TKA requires more bone resection than PKA and CPKA. These finite element analyses suggest that a longer-term benefit for bone is probable as partial and multi-compartmental knee procedures lead to more natural load transfer compared to TKA. High-flexion activity following TKA may be protective of posterior condyle bone resorption, which may help explain why bone loss affects some patients more than others. The male and female bone models used for this research are provided open access to facilitate future research elsewhere.

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The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty

Cited by 6 publications

References 50 publications

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review

Load transfer in bone after partial, multi-compartmental, and total knee arthroplasty

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