Basic ScienceThe Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty
Section snippets
Methods
The present study was performed in accordance with a fully validated FEM model of the proximal tibia [10]. Digital 3-dimensional data of the left tibia (Sawbone fourth-generation composite tibia; Pacific Research Laboratories, Inc, Vashon, Washington) were used to construct FEM models. In each of the FEM models, 112,110 to 757,170 nodes were placed depending on calculating status of analysis. A model of the left UKA tibial component was created from a commercially available design, TRIBRID
Results
The stress distributions on the exterior proximal cortical surface of the tibia in each model are shown in Figure 4. In all 15 models, a larger area of von Mises stress concentration was observed on the medial tibial metaphyseal cortex, and relatively smaller areas of principal stress concentration were observed on the anterior and posterior cortices in the corner of cut surfaces.
On the medial tibial metaphyseal cortex, the von Mises stress increased for the 2° extended cut and furthermore for
Discussion
Fracture of the medial tibial condyle after UKA is a serious complication and may be associated to surgical technique. The fracture lines of MTCFs begin from the corner of the tibial bone cut surfaces and reach the medial tibial metaphyseal cortex 6, 7. In the present FEM study, stress concentrations were observed on the medial tibial metaphyseal cortex and the anterior and posterior tibial cortices in the corner of cut surfaces in all models. Thus, we believe that the model generated in this
Conclusions
We investigated the effect of the coronal alignment of the tibial component and the notching of the posterior cortex on the stress concentration of the tibial cortex in UKA. The valgus inclination of the tibial component with the extended sagittal bone cut increased remarkably the stress concentration on the medial tibial metaphyseal cortex and the posterior tibial cortex. Placement of the tibial component using a large valgus inclination may increase the risk of MTCFs.
References (23)
- et al.
Yearly incidence of unicompartmental knee arthroplasty in the United States
J Arthroplasty
(2008) - et al.
Results of unicompartmental knee arthroplasty with cemented, fixed-bearing prosthesis using minimally invasive surgery
J Arthroplasty
(2010) - et al.
Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis
Knee
(2014) - et al.
lntra-operative tibial plateau fracture during unicompartmental knee replacement: a case report
Knee
(2003) - et al.
Tibial plateau stress fracture: a complication of unicompartmental knee arthroplasty using 4 guide pinholes
J Arthroplasty
(2003) - et al.
Periprosthetic tibial fractures in unicompartmental knee arthroplasty as a function of extended sagittal saw cut: an experimental study
Knee
(2010) - et al.
Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival?
Orthop Traumatol Surg Res
(2013) - et al.
Saw cuts in unicompartmental knee arthroplasty: an analysis of saw bone preparations
Knee
(2009) A Primer on UHMWPE
- et al.
Influence of changes in stem positioning on femoral loading after THR using a short-stemmed hip implant
Clin Biomech
(2007)
Stochastic finite element analysis of shells with combined random material and geometric properties
Comput Methods Appl Mech Engeg
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2022, Medical Engineering and PhysicsCitation Excerpt :Regarding the femoral component, only few studies reported that valgus alignment in coronal plane could increase the contact stress of polythene insert and collateral ligament strain [18]. It was noted that previous FEA studies were conducted under a given boundary condition with a fixed axial force and flexion angle [13–17] or with an artificial force control gait-cycle [19, 20]. Biomechanical effects of component mal-alignment on the knee joint were not investigated in the subject-specific ambulation.
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2021, KneeCitation Excerpt :Third, unlike the intact model, the surgical models could not be validated. However, this approach has been widely used in orthopedic biomechanics [26,27,29,31,35,47,51,52]. Fourth, the articular cartilage and ACL were considered elastic materials, and the effects of anisotropy and viscoelasticity were not considered.
No external funding was provided for this study.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.02.043.