Malposition of components and Femorotibial mechanical Axis changes on pressure distribution in Total knee arthroplasty

Tang, Jing; Wu, Tiemure; Shao, Hongyi; Zhou, Yixin

doi:10.1016/j.clinbiomech.2022.105659

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…Innocenti et al also used only one knee model. These findings were recently corroborated by Tang et al [ 24 ] using neutral alignment, 3°, 5°, and 7° of both varus and valgus of both components in all combinations.…”

Section: Discussionsupporting

confidence: 75%

Kinematic Alignment in Total Knee Arthroplasty Reduces Polyethylene Contact Pressure by Increasing the Contact Area, When Compared to Mechanical Alignment—A Finite Element Analysis

Klasan

Kapshammer

Miron

et al. 2022

JPM

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Unrestricted Kinematic alignment (KA) in total knee arthroplasty (TKA) replicates the joint line of each patient by adjusting the cuts based on the anatomy of the patient. Mechanical alignment (MA) aims to restore a neutral mechanical axis of the leg, irrespective of the joint line orientation. The purpose of the present study was to compare contact pressure and contact areas of the polyethylene (PE) bearing surface as well as von Mises stress of the PE-tibial tray interface for MA and KA in the same patient, using CT data and finite element analysis. Finite element models were created from lower leg CT scans of 10 patients with knee osteoarthritis with different phenotypes. Mechanical PE properties were experimentally determined by tensile tests on dumbbell specimens. For numerical simulation purposes an adjusted non-linear material model with the maximum load to failure of 30.5 MPa, was calibrated and utilized. Contact pressure points were the deepest parts of the polyethylene inlay. Contact pressures were either very similar or were increased for MA knees throughout the gait cycle. KA either increased or had a comparable contact area, compared to MA. KA and MA produced comparable von Mises stresses, although both alignments breached the failure point of 30.5 MPa in all 3 valgus knees. This might indicate a higher probability of failure at the inlay-tibial baseplate interface. By maintaining the joint line orientation, KA reduces or has comparable contact pressures on the PE bearing surface by increasing or maintaining the contact area throughout one gait cycle in a validated finite element analysis model in 10 different knee phenotypes. The von Mises stress on the PE-tibial component interface was comparable, except for the valgus knees, where the load to failure was achieved in both alignment strategies and slightly higher stresses were observed for KA. Further studies for different knee phenotypes are needed to better understand the pressure changes depending on the alignment strategy applied.

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Section: Discussionsupporting

confidence: 75%

Kinematic Alignment in Total Knee Arthroplasty Reduces Polyethylene Contact Pressure by Increasing the Contact Area, When Compared to Mechanical Alignment—A Finite Element Analysis

Klasan

Kapshammer

Miron

et al. 2022

JPM

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“…Femoral sagittal alignment with a γ angle between 0° and 3° was associated with the positive biomechanics in the finite element analyses [12, 13]. A varus or valgus coronal tibial alignment greater than 3° increases the risk of implant failure due to an imbalance in mediolateral compartmental pressure [2, 31]. Posterior tibial slope outside the range of 0–7° (≒ δ > 87 ± 3°) was associated with long‐term inferior survival [11].…”

Section: Discussionmentioning

confidence: 99%

Aseptic survival of the 1.5‐stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert

Song,

Hwang,

Baek

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). Methods Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1 month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was deined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors afecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°). Results The spacer in-situ time was 3.7 years (0.2-6.4). The clinical results improved hip-knee-ankle signiicantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0 years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a signiicant factor afecting survival (odds ratio = 5.491; p = 0.011). ConclusionThe aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty.

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“…Accurate alignment of tibiofemoral components is a critical element in obtaining favorable clinical outcomes for patients after total knee arthroplasty (TKA). Poor rotational alignment of tibiofemoral components can result in knee stiffness ( Bedard et al, 2011 ; Kim et al, 2014 ), evaluated joint contact stress ( Chen et al, 2015 ; Ueyama et al, 2020 ; Tang et al, 2022 ), and a high prevalence of TKA revisions ( Dalury et al, 2013 ; Panni et al, 2018 ; Rajgopal et al, 2022 ). Moreover, over 50% of patients who experienced joint pain after TKA had mal-rotational alignment of the knee components, which is a substantial contributor to joint pain and functional deficit ( Hofmann et al, 2003 ; Bell et al, 2014 ; Abdelnasser et al, 2019b ; Rajgopal et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Numerous computational studies have explored the impact of component malrotation on knee biomechanics during a walking gait after TKA using musculoskeletal multibody dynamics and finite element methods ( Kuriyama et al, 2014 ; Smith et al, 2016 ; Vanheule et al, 2017 ; Fang et al, 2022 ; Tang et al, 2022 ). Chen et al found that varus-valgus malrotation of the tibial/femoral component and internal-external malrotation of the femoral component with a 5° variation impacted peak medial contact force by 17.8%–53.1%, peak lateral contact force by 35.0%–88.4%, and peak total contact force by 5.2%–18.7% using a multibody dynamics model ( Chen et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning

Zhang,

Li,

Chen

et al. 2024

Front. Bioeng. Biotechnol.

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The precise alignment of tibiofemoral components in total knee arthroplasty is a crucial factor in enhancing the longevity and functionality of the knee. However, it is a substantial challenge to quickly predict the biomechanical response to malrotation of tibiofemoral components after total knee arthroplasty using musculoskeletal multibody dynamics models. The objective of the present study was to conduct a comparative analysis between a deep learning method and four conventional machine learning methods for predicting knee biomechanics with different tibial component malrotation during a walking gait after total knee arthroplasty. First, the knee contact forces and kinematics with different tibial component malrotation in the range of ±5° in the three directions of anterior/posterior slope, internal/external rotation, and varus/valgus rotation during a walking gait after total knee arthroplasty were calculated based on the developed musculoskeletal multibody dynamics model. Subsequently, deep learning and four conventional machine learning methods were developed using the above 343 sets of biomechanical data as the dataset. Finally, the results predicted by the deep learning method were compared to the results predicted by four conventional machine learning methods. The findings indicated that the deep learning method was more accurate than four conventional machine learning methods in predicting knee contact forces and kinematics with different tibial component malrotation during a walking gait after total knee arthroplasty. The deep learning method developed in this study enabled quickly determine the biomechanical response with different tibial component malrotation during a walking gait after total knee arthroplasty. The proposed method offered surgeons and surgical robots the ability to establish a calibration safety zone, which was essential for achieving precise alignment in both preoperative surgical planning and intraoperative robotic-assisted surgical navigation.

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Malposition of components and Femorotibial mechanical Axis changes on pressure distribution in Total knee arthroplasty

Cited by 4 publications

References 25 publications

Kinematic Alignment in Total Knee Arthroplasty Reduces Polyethylene Contact Pressure by Increasing the Contact Area, When Compared to Mechanical Alignment—A Finite Element Analysis

Kinematic Alignment in Total Knee Arthroplasty Reduces Polyethylene Contact Pressure by Increasing the Contact Area, When Compared to Mechanical Alignment—A Finite Element Analysis

Aseptic survival of the 1.5‐stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert

Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning

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