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Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study
A Completo1, F Fonseca, J A Simões
1Departamento de Engenharia Mecânica, Universidade de Aveiro, 3810-193 Aveiro, Portugal. completo@mec.ua.pt
Journal of Biomechanics
|November 27, 2007
Summary
Revision total knee arthroplasty (TKA) stems can cause stress shielding, potentially leading to bone loss. Cemented stems showed significant proximal shielding, while press-fit stems had less shielding but over a larger area.
Area of Science:
- Biomechanical engineering
- Orthopedic surgery
- Biomaterials science
Background:
- Revision total knee arthroplasty (TKA) commonly utilizes stemmed components to address limited bone stock.
- Concerns exist regarding stress shielding and potential bone loss associated with cemented or press-fit stems.
Purpose of the Study:
- To experimentally quantify strain shielding in synthetic tibias after revision TKA with different stem fixation methods.
- To compare the biomechanical effects of cemented versus press-fit stem augments on proximal tibial bone strains.
Main Methods:
- Cortical bone strains were measured using tri-axial strain gauges in synthetic tibias before and after in vitro TKA.
- Three tibias were implanted with cemented stems, press-fit stems, or a short monobloc stem (tibial tray only).
- Principal strain differences between intact and implanted tibias were calculated.
Main Results:
- A pronounced strain-shielding effect was observed proximally with cemented stem augments.
- Press-fit stems exhibited less proximal shielding but showed effects more extensively along the stem.
- Increased strains were noted near the distal tips of both cemented and press-fit stems.
Conclusions:
- Cemented stems may lead to proximal bone resorption due to significant stress shielding.
- Localized strain increases at stem tips could correlate with clinical reports of pain after revision TKA.
- Stem design and fixation method significantly influence stress distribution and bone remodeling potential.
