Relationship of design features of stemmed tibial knee prosthesis with stress shielding and end-of-stem pain

Completo, António; Talaia, Pedro; Fonseca, Fernando; Simões, J. A.

doi:10.1016/j.matdes.2008.06.071

Cited by 52 publications

(50 citation statements)

References 16 publications

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“…This reduction is maximized by not using bone cement for stem fixation. A plot outlining stress shielding for un-cemented stems can be seen below in Figure 9, as published by Completo A, Talaia P, Fonseca F, and Simões JA [23]. is indicative of stress shielding [23].…”

Section: Available Research Findings and Conclusionmentioning

confidence: 87%

“…This means that it should be expected that an initial state of stress shielding should be more noticeable for longer length stems. The proximal stress reduction in un-cemented long stems of 110mm have been shown to be reduced by 700%, compared to no stress shielding with stems of 50mm in length [23]. This reduction is maximized by not using bone cement for stem fixation.…”

Section: Available Research Findings and Conclusionmentioning

confidence: 99%

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A Finite Element Analysis of Tibial Stem Geometry for Total Knee Replacements

Bautista¹

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The purpose of this study was to investigate the influence of tibial stem geometry on stress shielding of the tibia for patients with a total knee replacement. Finite element analysis was used to study different tibial stem geometry types, as well as a vast array of different geometric sizes. Both a peg and stem type geometry were analyzed and compared in order to determine what type geometry causes the least amount of stress shielding. A static loading condition with a dynamic loading factor of three was used for the system and the stress responses were analyzed at regions of interest at various depths. Regions of interest include the posterior and medial regions, at depths ranging from the resurfaced tibial surface to 100 mm below the surface. It was found that the smallest stem/peg sizes produced the least amount of stress shielding, indicating that the less amount of foreign material within the tibia, the more natural the bending and stress response of the tibia. It was also concluded that for the loading conditions used in this study, peg type geometry yields a decreased amount of stress shielding when compared to stem type geometry. This is due to the fact that the peg type geometry allowed for more natural bending and a distributed loading transfer between two pegs rather than one long central stem. Further studies should be completed on other geometry types in order to understand how to best replicate the natural bending of the tibia.

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Section: Available Research Findings and Conclusionmentioning

confidence: 87%

Section: Available Research Findings and Conclusionmentioning

confidence: 99%

A Finite Element Analysis of Tibial Stem Geometry for Total Knee Replacements

Bautista¹

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“…It should however be noted that the modelled contact is not fully bonded but is frictional and thus can sustain relative motion if the friction is overcome. The press-fitted stem extension was chosen for modelling since this is the method considered to provide good clinical results in revision TKA in particular with regards to tibial alignment and ease of removal for further revisions [11]. In addition this was the fixation method used by the senior clinician on the stem extension where the metal plate attachment technique was applied.…”

Section: Methodsmentioning

confidence: 99%

“…Material properties were applied and all parts were assumed to be linearly elastic, homogenous and isotropic [11]. The material properties used for the various parts of the models are shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Analysis of Stem Tip Pain in Revision Total Knee Arthroplasty

Kimpton

Crocombe

Bradley

et al. 2013

The Journal of Arthroplasty

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“…The use of CT as a tool to obtain accurate values of density and then relate them with mechanical properties of the bone is common for numerical models. [12][13][14][15][16][17] Mechanical stresses over the bone stimulate the action of the osteoblast and can generate an increase of local bone density (ossification), 18 which is directly related to bone stiffness. [19][20][21] The ability of the bone to modify its shape and inner structure in response to a change in its load state is known as functional adaptation by remodelling, also known as Wolff`s Law.…”

mentioning

confidence: 99%

Analysis of bone demineralization due to the use of exoprosthesis by comparing Young’s Modulus of the femur in unilateral transfemoral amputees

Ramírez

Isaza

Mariaka

et al. 2011

Prosthetics &Amp; Orthotics International

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Background: There is a relation between Hounsfield units obtained from computed tomography (CT) scans and bone density. The density of the bones can be used to establish its mechanical properties and therefore to assess the bone mechanical condition using CT images. Objectives: To identify the effect of the transfemoral amputation and the use of external lower limb prosthesis in the bone properties, by comparing Young’s modulus. Study Design: Young’s modulus comparison. Methods: Comparison of bone density between the healthy femur and the amputated bone of 20 unilateral transfemoral amputees was done by generating three histograms of the Hounsfield units at different parts of the femur. The histograms were created based on images obtained by CT and the Hounsfield units were translated to Young’s modulus to establish the comparison. Results: The results show a significant difference ( p-value <0.05) between the mean value of Young’s modulus of healthy and amputated bone. Conclusions: There is clearly a direct association between the use of external prosthesis and the bone demineralization due the stress shielding phenomenon. The Young’s modulus comparison using information from CT images can be a suitable tool to analyze the bone demineralization due to the use of exoprosthesis.

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Relationship of design features of stemmed tibial knee prosthesis with stress shielding and end-of-stem pain

Cited by 52 publications

References 16 publications

A Finite Element Analysis of Tibial Stem Geometry for Total Knee Replacements

A Finite Element Analysis of Tibial Stem Geometry for Total Knee Replacements

Analysis of Stem Tip Pain in Revision Total Knee Arthroplasty

Analysis of bone demineralization due to the use of exoprosthesis by comparing Young’s Modulus of the femur in unilateral transfemoral amputees

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