Predicting friction at the bone – Implant interface in cementless total knee arthroplasty

Vries, Erik G. de; Sánchez, Esther; Janssen, Dennis; Matthews, D.T.A.; Heide, Emile van der

doi:10.1016/j.jmbbm.2022.105103

Cited by 13 publications

(6 citation statements)

References 55 publications

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“…In order to achieve basic stability during the postoperative period without the formation of an alignment, the resistance to movement between the bone and the implant is optimized by increasing the friction at the interface. This is necessary because excessive relative movements can inhibit bone growth due to wear and tear of the bone and formation of fibrous tissue at the implant interface, which can lead to loosening and pain (de Vries et al, 2022). Therefore, oversizing or malposition should be avoided when installing a tibial plateau prosthesis during TKA.…”

Section: Discussionmentioning

confidence: 99%

Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis

Zheng

Liu²,

Zhang³

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Poor prosthesis alignment during total knee arthroplasty could cause problems such as polyethylene spacer wear, leading to surgical failure and revision surgery. The problems caused by the malalignment of the tibial plateau prosthesis in the medial and lateral planes are unclear. We aimed to investigate the stress distribution and micromotion of the tibia when the tibial plateau prosthesis is translated 1 and 2 mm medially and laterally, respectively, using finite element analysis (FEA).Method: A non-homogeneous tibia model was created and load conditions when standing on two legs were applied using FEA to simulate the misaligned prosthesis. The stresses, stress distribution, and micromotion of the proximal tibia were analyzed in five positions of the tibial plateau prosthesis: Lateral-2 mm; Lateral-1 mm; Medium; Medial-2 mm; Medial-1 mm.Result: The maximum stress in the five groups with different misalignments of the platform was 47.29 MPa (Lateral-2 mm). The maximum micromotion among the five groups in different positions was 7.215 μm (Lateral-2 mm).Conclusion: When placing the tibial plateau prosthesis during total knee arthroplasty, an error of 2 mm or less is acceptable as long as it does not overhang.

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Section: Discussionmentioning

confidence: 99%

Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis

Zheng

Liu²,

Zhang³

et al. 2023

Front. Bioeng. Biotechnol.

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“…Dimensions of the stem specimens were measured at characteristic points and mean differences to the nominal dimension were −0.03 ± 0.13 mm (range: −0.49 to 0.25 mm). Since the roughness influences the primary implant stability, 29 it was measured for stems of group 1 and 3 using laser scanning microscopy (VK-X250, Keyence Germany GmbH, Neu-Isenburg, Germany) with 10-times magnification, λ S = 8, and λ C = 25. The mean roughness Ra were 19.5 ± 4.3 µm (group 1) and 21.4 ± 3.0 µm (group 3).…”

Section: Methodsmentioning

confidence: 99%

“…14,18,19,[22][23][24][25] It is influenced by bone density, surgical technique, implant material and design, the level of press-fit, and the magnitude and direction of the physiological loads. 14,18,19,23,24,[26][27][28][29] Regarding the response of human bone cells, small micromotions at the boneimplant interface are improving cell differentiation and bone formation at the interface. 30,31 But values greater than 0.15 mm are causing fibrous tissue formation 32 increasing the risk of implant failure.…”

Section: Introductionmentioning

confidence: 99%

Pre-clinical characterization of a novel flexible surface stem design for total knee replacements

Sass,

Hembus,

Fuhrmann

et al. 2023

Proc Inst Mech Eng H

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Primary stability is crucial for implant osseointegration and the long-term stability of cementless total joint replacements. Biomechanical studies have shown the potential of femoral stems for total knee replacements to reduce micromotions at the bone-implant interface. However, approaches such as focusing on the structural elasticity of the femoral stems are rarely described. Three groups with different femoral stem designs were investigated: group 1: flexible surface stem, group 2: flexible surface stem with open-porous structured lamellas, and group 3: solid stem (reference). The stems were implanted into bone substitute material and dynamically loaded for 1000 cycles. Relative movement and subsidence were measured optically, and axial pull-out forces were determined after dynamic testing. Relative movements increased to 0.10 mm (groups 1 and 2) compared to 0.03 mm (group 3). Subsidence increased to 0.08 mm (group 1) and 0.11 mm (group 2) compared to 0.06 mm (group 3). For each group, subsidence mainly occurred during the first 500 cycles. A similar convergence was observed in the further course. Pull-out forces increased to 1815.0 N (group 1) and 1347.1 N (group 2) compared to 1306.4 N (group 3). The flexible surface stem design resulted in higher relative movements and subsidence, but also exhibited increased pull-out forces. The relative movements were below the critical limit of 0.15 mm and represent a superposition of the elastic deformations of the interacting implant components as well as the micromotion at the bone-implant interface. Therefore, the novel flexible surface stem design appears to offer promising primary implant fixation.

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“…Most previous literature has been confined to experimental studies on the femoral TKA component. These studies established that postoperative primary fixation for cementless implants depends on the magnitude of the interference fit and the coefficient of friction [12][13][14][15]. These studies concluded that a higher coefficient of friction achieves superior primary fixation.…”

Section: Introductionmentioning

confidence: 92%

A Study on the Effects of Cementless Total Knee Arthroplasty Implants’ Surface Morphology via Finite Element Analysis

Hunt,

Noori,

Hazelwood

et al. 2024

BioMedInformatics

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Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries, with nearly one million performed in 2020 in the United States alone. Changing patient demographics, predominately indicated by increases in younger, more active, and more obese patients undergoing TKA, poses a challenge to orthopedic surgeons as these factors present a greater risk of long-term complications. Historically, cemented TKA has been the gold standard for fixation, but long-term aseptic loosening continues to be a risk for cemented implants. Cementless TKA, which relies on the surface morphology of a porous coating for biologic fixation of implant to bone, may provide improved long-term survivorship compared with cement. The quality of this bond is dependent on an interference fit and the roughness, or coefficient of friction, between the implant and the bonebone. Stress shielding is a measure of the difference in the stress experienced by implanted bone versus surrounding native bone. A finite element model (FEM) can be used to quantify and better understand stress shielding in order to better evaluate and optimize implant design. In this study, a FEM was constructed to investigate how the surface coating of cementless implants (coefficient of friction) and the location of the coating application affected the stress-shielding response in the tibia. It was determined that the stress distribution in the native tibia surrounding a cementless TKA implant was dependent on the coefficient of friction applied at the tip of the implant’s stem. Materials with lower friction coefficients applied to the stem tip resulted in higher compressive stress experienced by implanted bone, and more favorable overall stress-shielding responses.

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Predicting friction at the bone – Implant interface in cementless total knee arthroplasty

Cited by 13 publications

References 55 publications

Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis

Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis

Pre-clinical characterization of a novel flexible surface stem design for total knee replacements

A Study on the Effects of Cementless Total Knee Arthroplasty Implants’ Surface Morphology via Finite Element Analysis

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