Finite element assessment of block-augmented total knee arthroplasty

Frehill, B; Crocombe, A.D.; Agarwal, Yash; Bradley, William Neil

doi:10.1080/10255842.2014.948429

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Several other studies also investigated reconstruction of AORI IIA defects. Completo et al, used synthetic tibiae and finite element models to simulate how different reconstruction technique (cemented step augment, wedge augment, and stem alone) affect the survival of revision procedure while Frehill et al used FEA to simulate the effect of different reconstruction techniques (metal wedge, metal step, cement wedge, and cement step) on implant stability. To date no study simulated the role of sleeves in providing implant stability when reconstructing type IIB defects.…”

mentioning

confidence: 99%

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

Awadalla

Al-Dirini

O’Rourke

et al. 2019

Journal Orthopaedic Research

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Metaphyseal augments, such as sleeves, have been introduced to augment the fixation of revision total knee replacement (rTKR) components, and can be used with or without a stem. The effect of sleeve size in combination with stems on the primary stability and load transfer of a rTKR implant in AORI type IIB defects where the defect involves both condyles are poorly understood. The aim of this study was to examine the primary stability of revision tibial tray augmented with a sleeve in an AORI type IIB defect which involves both condyles with loss of cortical and cancellous bone. Finite element models were generated from computed tomography (CT) scans of nine individuals. All the bones used in the study had an AORI type IIB defect. The cohort included eight females (mean weight: 64 kg, height: 1.6 m). Material properties were sampled from CT data and assigned to the FE model. Joint contact forces for level gait, stair descent, and squat were applied. Stemless sleeved implants under various loading conditions were shown to have adequate primary stability in all AORI type IIB defects investigated. Adding a stem only marginally improved the primary stability of the implant but reduced the strain in the metaphysis compared to stemless implants. Once good initial mechanical stability was established with a sleeve, there was no benefit, in terms of primary stability or bone strains, from increasing sleeve size. This study suggests that metaphyseal sleeves, without a stem, can provide the required primary stability required by a rTKR tibial implant, to reconstruct an AORI type IIB defect. ß

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mentioning

confidence: 99%

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

Awadalla

Al-Dirini

O’Rourke

et al. 2019

Journal Orthopaedic Research

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“…A vertical load of 1618 N (2.2 times body weight, representing a 75‐kg person) was applied to the composite tibia through the tibial insert, 14,15 and a medial and lateral condyle force ratio (6:4) was used in this study according to previous studies 16 …”

Section: Methodsmentioning

confidence: 99%

“…A vertical load of 1618 N (2.2 times body weight, representing a 75‐kg person) was applied on the 3D‐printed holder using a mechanical testing machine (Instron Co., USA) 14,15 . The vertical load was increased linearly incrementally with 50‐N intervals.…”

Section: Methodsmentioning

confidence: 99%

Stability of Three‐Dimensional Printed Custom‐Made Metaphyseal Cone for Tibial Bone Defects Reconstruction: A Finite Element Analysis and Biomechanical Study

Wang,

Li,

Wang

et al. 2023

Orthopaedic Surgery

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ObjectivesThe reconstruction of bone defects in tibial revision knee arthroplasty is challenging. In this study, we evaluated the primary stability of a novel three‐dimensional (3D)‐printed custom‐made metaphyseal cone for Anderson Orthopedic Research Institute (AORI) IIb or III bone defect reconstruction in tibial revision knee arthroplasty using the combination of finite‐element analysis and biomechanical experiments.MethodsIn the finite‐element analysis, AORI II b and III medial tibial bone defects were designed at varying depths. A novel 3D‐printed custom‐made metaphyseal cone was designed and used to reconstruct the bone defect with or without a stem in simulated revision total knee arthroplasty (RTKA). A no‐stem group and a stem group were established (based on whether a stem was used or not). Von Mises stress and micromotion were calculated with varying depths of bone defects, ranging from 5 mm to 35 mm, and then micromotions at the bone–implant interface were calculated and compared with the critical value of 150 μm. In the biomechanical experiment, the no‐stem group was used, and the same bone defects were made in four synthetic tibias using patient‐specific instruments. Micromotions at the bone–implant interface were investigated using a non‐contact optical digital image correlation system and compared with the critical value of 150 μm.ResultsWhen the bone defect was <30 mm, micromotions at the bone–implant interface in the finite‐element analysis were all below 150 μm both in the stem groups and no‐stem groups, whereas those in the biomechanical experiment were also below 150 μm in the no‐stem group.ConclusionsThe 3D‐printed custom‐made metaphyseal cone in RTKA has excellent primary stability and does not require stems in reconstructing tibial AORI type IIb or III bone defects with a depth of <30 mm.

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“…The modulus of the cortical bone was used by Frehill et al [ 14 ], and it is within the modulus range cited and used by other authors. The value of the cancellous modulus used is within the range of values (389-1132 MPa) cited and obtained experimentally by Au et al for cancellous bone [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…Ritter [ 11 – 13 ] reported successful results at early, intermediate, and long-term follow-up after use of the screw and cement technique to correct large tibial defects (5-30 mm). However, in previous studies, the number and insertion angle of screws were chosen based on personal experience, to fill a given medial tibial defect, previous authors have used as many screws as possible to ensure the stability of the tibial prosthesis [ 14 – 18 ], and no published study has determined the optimal number of screws or whether differences exist between the two different frequently used screw insertion angles. The purpose of this study was to perform a finite element (FE) assessment to determine the effect of different numbers of screws on the stability of TKA for two types of moderate uncontained type-2 defects and to determine whether differences exist between two different screw insertion angles.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty

Zheng

et al. 2020

BioMed Research International

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Background. The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. Method. Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with cement were generated. Contact stresses on the surface of cancellous bone in different areas were calculated. Results. Compared to the cement-only technique, the stress on the border of cancellous bone and bone cement decreased by 10% using the screw and cement technique. For bone defects with a 12% defect area and a 12-mm defect depth, the use of 1 screw achieved the greatest stability; for those with a 15% defect area and a 20-mm defect depth, 2 screws achieved the greatest stability. Conclusions. (1) The screw and cement technique is superior to the bone cement-only technique. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better.

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Finite element assessment of block-augmented total knee arthroplasty

Cited by 6 publications

References 16 publications

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

Stability of Three‐Dimensional Printed Custom‐Made Metaphyseal Cone for Tibial Bone Defects Reconstruction: A Finite Element Analysis and Biomechanical Study

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty

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