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Assessing Implant Stability in Cementless Femoral Components With Different Interference Fits.

Esther Sánchez1, Christoph Schilling2, Thomas M Grupp2,3

  • 1Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|October 3, 2025
PubMed
Summary

Optimizing interference fit in cementless total knee arthroplasty is key. Higher fits don't improve stability but increase bone plasticity and potential damage.

Keywords:
bone plasticitybone‐implant interfacecementless implantsfinite element analysis (FEA)interference fitmicromotionprimary stabilitytotal knee arthroplasty (TKA)

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Materials Science

Background:

  • Cementless total knee arthroplasty (TKA) offers bone preservation and easier revisions compared to cemented options.
  • Achieving optimal press-fit fixation is crucial for primary and long-term stability in cementless TKA, but the ideal interference fit remains unclear.

Purpose of the Study:

  • To investigate the biomechanical effects of two different interference fits (350 µm and 700 µm) on cementless femoral components.
  • To analyze the impact of interference fit on micromotions, gap formation, and plastic bone deformation at the bone-implant interface.

Main Methods:

  • Utilized finite element analysis (FEA) with models derived from microCT and optical scans of cadaveric femurs.
  • Quantified micromotions as shear displacement and gaps as normal displacement.
  • Assessed bone response by measuring the volume of bone experiencing total equivalent plastic strain.

Main Results:

  • FEA models showed moderate correlation with experimental data, explaining 35% of displacement variability.
  • Higher interference fit (700 µm) showed a non-significant trend towards reduced micromotions and gaps (p=0.252 and p=0.759).
  • Significantly greater plastic deformation occurred with the higher interference fit (+15.7%, p=0.031), especially at the posterior femoral condyles.

Conclusions:

  • Increased interference fit in cementless TKA does not significantly enhance primary stability.
  • Higher interference fits lead to increased bone plasticity, potentially causing more bone damage.
  • Optimizing the interference fit is essential to balance implant fixation and minimize adverse bone responses.