Three-Dimensional Finite Analysis of the Optimal Alignment of the Tibial Implant in Unicompartmental Knee Arthroplasty

Sasatani, Katsumi; Majima, Tokifumi; Murase, Kohei; Takeuchi, Naoki; Matsumotο, Takeo; Oshima, Yasushi; Takai, Shinro

doi:10.1272/jnms.jnms.2020_87-202

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…Ten (12%) studies were case reports [15,40,52,60,69,74,81,82,87,92]. Thirteen (16%) were laboratory studies, of which four (31%) used sawbones [16,20,39,64], four (31%) inite element models [41,42,75,76], three (23%) human cadavers [21,79,80] and two (15%) a combination of inite element models with sawbones [19,71]. The quality of studies was considered to be good in 54 (67%) studies, fair in 26 (32%) studies, and poor in one (1%) study.…”

Section: Resultsmentioning

confidence: 99%

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis

Burger

Jager

Dooley

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. Methods Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. Results A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64–2.41) for cementless and 1.58% (95%CI 1.06–2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. Conclusion Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. Level of evidence V.

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Section: Resultsmentioning

confidence: 99%

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis

Burger

Jager

Dooley

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Examples of such cases include bone fractures, collapses resulting from mechanical overload, or press-fit fixation of an implant. Finite element analysis (FEA) has proven to be a powerful tool for assessing these types of permanent deformations [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The application of an isotropic crushable foam model to predict the femoral fracture risk

et al. 2023

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For biomechanical simulations of orthopaedic interventions, it is imperative to implement a material model that can realistically reproduce the nonlinear behavior of the bone structure. However, a proper material model that adequately combines the trabecular and cortical bone response is not yet widely identified. The current paper aims to investigate the possibility of using an isotropic crushable foam (ICF) model dependent on local bone mineral density (BMD) for simulating the femoral fracture risk. The elastoplastic properties of fifty-nine human femoral trabecular cadaveric bone samples were determined and combined with existing cortical bone properties to characterize two forms of the ICF model, a continuous and discontinuous model. Subsequently, the appropriateness of this combined material model was evaluated by simulating femoral fracture experiments, and a comparison with earlier published results of a softening Von-Mises (sVM) material model was made. The obtained mechanical properties of the trabecular bone specimens were comparable to previous findings. Furthermore, the ultimate failure load predicted by the simulations of femoral fractures was on average 79% and 90% for the continuous and discontinuous forms of the ICF model and 82% of the experimental value for the sVM material model. Also, the fracture locations predicted by ICF models were comparable to the experiments. In conclusion, a nonlinear material model dependent on BMD was characterized for human femoral bone. Our findings indicate that the ICF model could predict the femoral bone strength and reproduce the variable fracture locations in the experiments.

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“…8 The stress to the implant with inadequate postoperative alignment works as shear stress and causes loosening to both varus and valgus knees. 9 Due to the limited number of cases of UKA, it is difficult to determine the acceptable alignment range in detail for this procedure from the clinical data available. The finite element method (FEM) has made structural analysis possible under all conditions by the use of computer simulation and is often used to optimize the structural design of implants.…”

Section: Introductionmentioning

confidence: 99%

Finite-Element Analysis of Stress on the Proximal Tibia After Unicompartmental Knee Arthroplasty

et al. 2020

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Background: Because the indications for UKA are limited, the number of patients who have undergone this procedure is small, and it is therefore difficult to decide the acceptable range of variation in the details of this surgical procedure on the basis of the available clinical data. The objective of the present study was to determine the factors affecting the stress distribution of the proximal tibia after UKA. Methods: The two-dimensional finite element analysis in the proximal tibia was employed to assess the following four factors: 1) Two types of implants, all-ultra-high molecular weight polyethylene (UHMWPE) type and metal backed type, 2) postoperative alignment, 3) coverage of tibial bone, 4) level of the tibial osteotomy. Results: In the cases of varus alignment, high stress and large deformation was observed on and beneath the implant. In the cases of valgus alignment, stress concentration was seen at the lateral portion of tibial tray. In comparison with the standard model, the stress concentration was observed at the medial edge of the medial condyle in a narrow coverage model. Comparing to the standard model, the stress distribution in a low osteotomy level model did not differ markedly from that in the standard model. Metal 3 backed implants were shown to provide better stress distribution than UHMWPE implants in this study. Conclusions: The proper postoperative alignment must be achieved in UKA. The osteotomy level should be set at the cancellous bone close to the joint line, and maximum bone stock should be preserved.

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Three-Dimensional Finite Analysis of the Optimal Alignment of the Tibial Implant in Unicompartmental Knee Arthroplasty

Cited by 8 publications

References 13 publications

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis

The application of an isotropic crushable foam model to predict the femoral fracture risk

Finite-Element Analysis of Stress on the Proximal Tibia After Unicompartmental Knee Arthroplasty

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