The effect of malalignment on stresses in polyethylene component of total knee prostheses – a finite element analysis

Liau, Jiann‐Jong; Cheng, Cheng‐Kung; Huang, Chin Chou; Lo, Wai‐Hee

doi:10.1016/s0268-0033(01)00109-7

Cited by 156 publications

(119 citation statements)

References 19 publications

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“…Accurate knowledge of in vivo articular contact kinematics and contact forces at tibiofemoral interfaces has important implications for analyzing factors limiting longevity of TKA components, such as aseptic loosening of implants and polyethylene component wear (Au, et al, 2007, Liau, et al, 2002. Our study presented simultaneous measurement of tibiofemoral articular contact forces and 3D articular contact kinematics in 3 TKA patients.…”

Section: Discussionmentioning

confidence: 99%

“…These data may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models (Zhao, et al, 2007). This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs (Au, et al, 2007, Liau, et al, 2002. Musculoskeletal models of the lower limb would also benefit from the availability of accurate data against which they can be validated (D'Lima, et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

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In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Varadarajan

Moynihan

D’Lima

et al. 2008

Journal of Biomechanics

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Analysis of polyethylene component wear and implant loosening in total knee arthroplasty (TKA) requires precise knowledge of in vivo articular motion and loading conditions. This study presents a simultaneous, in vivo measurement of tibiofemoral articular contact forces and contact kinematics in three TKA patients. These measurements were accomplished via a dual fluoroscopic imaging system and instrumented tibial implants during dynamic single leg lunge and chair risingsitting. The measured forces and contact locations were also used to determine mediolateral distribution of axial contact forces. Contact kinematics data showed a medial pivot during flexion of the knee, for all patients in the study. Average axial forces were higher for lunge compared to chair rising-sitting (224% body weight vs. 187% body weight). In this study we measured peak anteroposterior and mediolateral forces averaging 13.3% BW, during lunge and 18.5% BW during chair rising-sitting. Mediolateral distributions of axial contact force were both patient and activity specific. All patients showed equitable medial-lateral loading during lunge but greater loads at the lateral compartment during chair rising-sitting. The results of this study may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models. This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Varadarajan

Moynihan

D’Lima

et al. 2008

Journal of Biomechanics

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“…The long-held tenet in TKA of restoration of a neutral overall mechanical axis (OMA) is supported by numerous biomechanical [28], finite element [2,44], and clinical studies [5,17,27,35,47,48,52,70,84], both historical and contemporary, demonstrating increased strain, higher failure rates, and, in many cases, lower functional scores with coronal malalignment. Recently, three-dimensional imaging and custom manufacturing have enabled the development of patient-specific positioning guides (PSPGs).…”

Section: Introductionmentioning

confidence: 99%

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

DeClaire

Berend

et al. 2012

Clinical Orthopaedics &Amp; Related Research

285

243

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Background Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. Questions/purposes We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. Methods We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. Results The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3°hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9°versus 90.4°) and femoral (90.7°versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the

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“…Despite recent challenges, the literature overwhelmingly stresses the importance in the mechanical axis in assuring the longevity of knee replacements [9][10][11][12][13][14]. Malalignment has been found to be the factor responsible for 9.4 %-11.8 % of total knee revisions [38,39].…”

Section: Literature Reviewmentioning

confidence: 99%

“…However a preponderance of classic and contemporary evidence supports increased failure rates with malalignment, especially varus [9][10][11][12][13][14]. Computer navigation was developed to assist surgeons in achieving a neutral mechanical axis.…”

Section: Introductionmentioning

confidence: 99%

Customization of cutting blocks: Can this address the problem?

Lombardi¹,

Frye²

2012

Curr Rev Musculoskelet Med

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Recent literature has challenged the notion that neutral coronal alignment is a requirement for long-term survivorship of TKAs. However a preponderance of classic and contemporary evidence supports increased failure rates with malalignment, especially varus. Patient-specific custom cutting guides are an attractive alternative to traditional instrumentation and computer navigation in achieving accurate alignment of total knee arthroplasties. The logistical benefits include possible decreased operating room time, decreased turnover time, less time spent sterilizing and preparing trays, less inventory, less strain on surgical technicians and nurses, and no capital cost associated with computer navigation. Patient benefits include potentially less tourniquet time, less surgical exposure, no requirement of intramedullary canal preparation, and improved mechanical alignment, which may translate to increased implant longevity. Surgeon benefits include potentially more accurate landmark registration than computer navigation, more efficient surgery, decreased intraoperative stress due to less required decision making, and the ability to perform more surgeries due to time saved.

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The effect of malalignment on stresses in polyethylene component of total knee prostheses – a finite element analysis

Cited by 156 publications

References 19 publications

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

Customization of cutting blocks: Can this address the problem?

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