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Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study
Bilal Farouk El-Zayat1, Thomas J Heyse2, Nelson Fanciullacci3
1Center of Orthopaedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35033, Marburg, Germany. elzayat@med.uni-marburg.de.
Archives of Orthopaedic and Trauma Surgery
|October 6, 2016
Summary
Long cemented stems in revision total knee arthroplasty (TKA) reduce bone stress and micromotion. Cementless stems increase stress and micromotion, potentially causing stem-end pain.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Finite Element Analysis
Background:
- Lack of guidelines for stem length and cementing in revision total knee arthroplasty (TKA).
- Need to understand biomechanical effects of different stem configurations.
Purpose of the Study:
- Compare stresses and relative movement of cemented vs. uncemented stems of varying lengths in revision TKA.
- Utilize finite element analysis to evaluate biomechanical performance.
Main Methods:
- Developed a finite element model of a synthetic tibia.
- Simulated two stem lengths (95mm and 160mm) with cemented and press-fit fixation.
- Analyzed stress distribution and implant micromotions during simulated lunge and squat tasks.
Main Results:
- Both long and short stems in revision TKA resulted in high stresses, particularly at the stem tip.
- Cementing stems significantly reduced bone stresses across all regions.
- Press-fit stems exhibited greater micromotion than cemented stems.
Conclusions:
- Long cemented stems demonstrated the lowest stress and micromotion.
- Cementless stems led to increased micromotion and stress, potentially explaining stem-end pain.
- Findings aid surgeons in selecting optimal implants for revision TKA.
