Stability and anchorage considerations for cementless tibial components

Dempsey, A. J.; Finlay, J. B.; Bourne, R.B.; Rorabeck, Cecil H.; Scott, Michelle; Millman, J.C.

doi:10.1016/s0883-5403(89)80018-x

Cited by 18 publications

(4 citation statements)

References 9 publications

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“…The material properties of the corticocancellous region of the proximal tibia are complex. Finite element models have used material parameters based on the properties of polyurethane foam for cancellous bone,15, 16 published elastic properties from indentation testing,10, 12 and CT density‐based calculations for spatially varying elastic properties 14. While finite element models can simulate complex biomechanical conditions, few have been validated experimentally 14, 16…”

mentioning

confidence: 99%

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

Wong

Steklov

Patil

et al. 2010

Journal Orthopaedic Research

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Tibial tray malalignment has been associated with increased subsidence and failure. We constructed a finite element model of knee arthroplasty to determine the biomechanical factors involved in increasing the risk of subsidence with malalignment. Four fresh-frozen human knees were implanted with a tibial tray and subjected to forces representative of walking for up to 100,000 cycles. Cyclic displacement was measured between the tray and proximal tibia. The vertical load was shifted medially to generate a load distribution ratio of 55:45 (medial/lateral) to represent neutral alignment or 75:25 to represent varus alignment. Subjected specific geometry and material properties were obtained from qCT scans of tibia to construct a finite element model. The tray was subjected to a single load cycle representing experimental conditions. Tray displacement computed by the model matched that measured experimentally. Forces representing varus tray alignment generated greater strains in the proximal tibia and a greater volume of bone was subjected to strains higher than the fatigue threshold. Local compressive strains directly correlated with experimental subsidence and failure. Our results indicate that failure after tray malalignment is likely due to fatigue damage to the proximal tibia rather than shear across the implant-bone interface or failure of the cement mantle. ß

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mentioning

confidence: 99%

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

Wong

Steklov

Patil

et al. 2010

Journal Orthopaedic Research

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“…36 In the interest of investigating aseptic loosening in cementless tibial trays, several previous studies have been undertaken to assess the mechanical stability of an implanted tibial tray through bench testing and finite element analysis. [21][22][23][37][38][39][40][41][42][43][44][45] Many of these studies have used simplified loading models to assess tibial tray stability, while a few more recent studies have included more complex loading scenarios. 25,37 More recently, radiostereometric analysis has been paired with mechanical testing to evaluate cementless tibial component subsidence in cadaveric models, with median subsidence reported between 0.5 and 2.5 mm.…”

Section: Discussionmentioning

confidence: 99%

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

et al. 2019

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Highly porous ingrowth surfaces have been introduced into tibial tray fixation to improve long-term survivorship in cementless total knee arthroplasty. This study was designed to evaluate the effect of porous ingrowth surface on primary stability in the implanted cementless tibial component. Three tibial tray designs possessing sintered bead or roughened porous coating ingrowth surfaces were implanted into a foam tibia model with primary stability assessed via digital image correlation during stair descent and condylar liftoff loading. Follow-up testing was conducted by implanting matched-pair cadaveric tibias with otherwise identical trays with two iterations of ingrowth surface design. Trays were loaded and micromotion evaluated in a condylar liftoff model. The sintered bead tibial tray exhibited slightly lower micromotion than the roughened porous coating in stair descent loading. However, no significant difference in primary stability was observed in condylar liftoff loading in either foam or cadaveric specimens. Cementless tibial trays featuring two different iterations of porous ingrowth surfaces demonstrated both good stability in cadaveric specimens with less than 80 microns of micromotion and 1 mm of subsidence under cyclic loading. While improved ingrowth surfaces may lead to improved biological fixation and long-term osteointegration, this study was unable to identify a difference in primary stability associated with subsequent ingrown surface design iteration.

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“…1995, Bloebaum et al 1997. It has been reported that bone ingrowth into porous coating is dependent on adequate initial stability, implant design, and surgical technique (Dempsy et al 1989). In addition, the presence of osteogenic precursor cells in bone marrow is essential for bone ingrowth to occur (Spector 1988).…”

Section: Background and Purpose Poor Bone Ingrowth Into The Porous Comentioning

confidence: 99%

Effect of bone marrow grafting on the titanium porous-coated implant in bilateral total knee arthroplasty

et al. 2007

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Stability and anchorage considerations for cementless tibial components

Cited by 18 publications

References 9 publications

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

Effect of bone marrow grafting on the titanium porous-coated implant in bilateral total knee arthroplasty

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