The influence of different tibial stem designs in load sharing and stability at the cement–bone interface in revision TKA

Completo, António; Simões, J. A.; Fonseca, Fernando; Oliveira, Mónica

doi:10.1016/j.knee.2008.01.008

Cited by 73 publications

(67 citation statements)

References 38 publications

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“…The bone strains predicted here reached approximately 1500 microstrains below the stem, 1000 along the stem and 100 under the baseplate. The bone strains after knee arthroplasty with long stems (revision surgery) have been measured in cadaveric bones (Reilly et al 1982;Bourne and Finlay 1986;Jazrawi et al 2001), synthetic bones (Completo et al 2008) and numerical models (Completo et al 2007). A strict comparison with the above more realistic models was rather difficult because of the different experimental conditions.…”

Section: Discussionmentioning

confidence: 99%

“…In general, this stability is achieved by using longer stems, either for the tibial or femoral components (Bugbee et al 2001). The stem used in the tibial part is cemented or press-fitted inside the medullary canal (Completo et al 2008;Kim et al 2008). Although the RKA is quite common, its success rate is not as good as the primary fixation (Su et al 2000).…”

Section: Introductionmentioning

confidence: 99%

“…However, the bone defects are usually replaced either with bone grafts (autografts, allografts and xenografts), metallic augments, cement (Stockley et al 1992;Mow and Wiedel 1996;van Loon et al 1999;Completo et al 2008). Each one of these substitutes has certain advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

Terrier

Sedighi-Gilani

Ghias

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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Tibial bone defect is a critical problem for revision knee arthroplasty. Instead of using metallic spacer or cement, biodegradable scaffolds could be an alternative solution. A numerical model of a revision knee arthroplasty was thus developed to estimate the mechanical resistance of the scaffold in this demanding situation. The tibia, scaffold, and prosthesis were represented by simplified parameterised geometries. The maximal gait cycle force was applied asymmetrically to simulate a critical loading. Several parameters were analysed: 1) inter-individual variability, 2) cortical bone stiffness, 3) cortical bone thickness, 4) prosthesis fixation quality, and 5) scaffold thickness. The calculated scaffold strain was compared to its experimental ultimate strain. Among the tested parameters, failure was only predicted with scaffold thickness below 5 mm. This study suggests that biodegradable bone scaffolds could be used to fill bone defects in revision knee arthroplasty, but scaffold size seems to be the limiting factor.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

Terrier

Sedighi-Gilani

Ghias

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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“…Despite their effectiveness in diaphyseal stem fixation, press-fit stems may give rise to problems, including the need for offset capability when diaphyseal engagement causes implant malalignment, as well as iatrogenic fracture and end of stem pain. Finally, uncemented stems appear to have less of an effect on metaphyseal bone density, although radiolucent lines of uncertain significance can develop around stems over time [14,15].…”

Section: Stem Typesmentioning

confidence: 98%

The role of offset stems in revision knee arthroplasty

Baldini¹,

Balato

Franceschini

2015

Curr Rev Musculoskelet Med

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Revision total knee arthroplasty (TKA) represents a technically challenging procedure. The use of an offset stem extension can help in addressing some of the difficulties that can be encountered during surgery and, in particular, anatomical mismatch, malalignment, and gap balancing. Different offset stem extensions are available and can be classified according to four parameters: modularity, location of the offset, direction, and size of the displacement. Offset stem extensions can assist with implant alignment on the metaphysis if there is an offset diaphysis, can avoid medial-lateral or anterior-posterior component overhang, can reduce the incidence of coronal or sagittal malalignment, and can help in balancing the flexion and extension spaces by effectively translating the components. The aim of this study is to give an overview of the currently available evidence regarding the use of offset stem extensions in revision TKA as well as some useful surgical tips.

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“…Assuming level walking, axial force of 2.5 BW was applied on the PE (60% medial, 40% lateral), shear force of 0.5 BW was applied on the PE-directed anteriorly and patello-femoral force of 0.8 BW was applied to the insertion point of the patellar ligament on the tibia (Figure 2(b) (Taylor et al 1998). The contact between all parts was assumed to be glued (Completo et al 2008). The outcome of the RKA model was the average value of strain induced in the RKA scaffold.…”

Section: Defining Clinical Application: Finite Element Model Of Rka (mentioning

confidence: 99%

Translation of Biomechanical Concepts in Bone Tissue Engineering: From Animal Study to Revision Knee Arthroplasty

Ghias¹,

Terrier²,

Jolles-Haeberli³

et al. 2012

Journal of Biomechanics

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Bone defects in revision knee arthroplasty are often located in load-bearing regions. The goal of this study was to determine whether a physiologic load could be used as an in situ osteogenic signal to the scaffolds filling the bone defects. In order to answer this question, we proposed a novel translation procedure having four steps: (1) determining the mechanical stimulus using finite element method, (2) designing an animal study to measure bone formation spatially and temporally using micro-CT imaging in the scaffold subjected to the estimated mechanical stimulus, (3) identifying bone formation parameters for the loaded and non-loaded cases appearing in a recently developed mathematical model for bone formation in the scaffold and (4) estimating the stiffness and the bone formation in the bone-scaffold construct. With this procedure, we estimated that after 3 years mechanical stimulation increases the bone volume fraction and the stiffness of scaffold by 1.5-and 2.7-fold, respectively, compared to a non-loaded situation.

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The influence of different tibial stem designs in load sharing and stability at the cement–bone interface in revision TKA

Cited by 73 publications

References 38 publications

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

The role of offset stems in revision knee arthroplasty

Translation of Biomechanical Concepts in Bone Tissue Engineering: From Animal Study to Revision Knee Arthroplasty

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