1
|
Innocenti B, Bori E, Pianigiani S. Biomechanical Analysis of the Use of Stems in Revision Total Knee Arthroplasty. Bioengineering (Basel) 2022; 9:bioengineering9060259. [PMID: 35735502 PMCID: PMC9220056 DOI: 10.3390/bioengineering9060259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Adequate fixation is fundamental in revision total knee arthroplasty; consequently, surgeons must determine the correct set-up for each patient, choosing from numerous stem solutions. Several designs are currently available on the market, but there are no evidence-based quantitative biomechanical guideline yet. Therefore, several stems were designed and analyzed using a previously-validated finite-element model. The following parameters were studied: stem design characteristics (length and shape), added features (straight/bowed stem), fixation technique, and effect of slots/flutes. Bone stress and Risk of Fracture (RF) were analyzed in different regions of interest during a squat (up to 120°). For the femoral stem, the results indicated that all parameters influenced the bone stress distribution. The maximum von Mises stress and RF were always located near the tip of the stem. The long stems generated stress-shielding in the distal bone. Regarding the tibial stem, cemented stems showed lower micromotions at the bone-tibial tray interface and at the stem tip compared to press-fit stems, reducing the risk of implant loosening. The results demonstrated that anatomical shapes and slots reduce bone stress and risk of fracture, whereas flutes have the opposite effect; no relevant differences were found in this regard when alternating cemented and press-fit stem configurations. Cemented tibial stems reduce antero-posterior micromotions, preventing implant loosening.
Collapse
|
2
|
Innocenti B, Fekete G, Pianigiani S. Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty. J Biomech Eng 2018; 140:2694847. [PMID: 30098138 DOI: 10.1115/1.4040966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.
Collapse
Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| | - Gusztáv Fekete
- Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, Károlyi Gáspár 4, 9700 Szombathely, Hungary
| | - Silvia Pianigiani
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| |
Collapse
|
3
|
Hast MW, Piazza SJ. Position of the quadriceps actuator influences knee loads during simulated squat testing. J Biomech 2018; 73:227-232. [PMID: 29576314 DOI: 10.1016/j.jbiomech.2018.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/02/2018] [Accepted: 03/09/2018] [Indexed: 11/24/2022]
Abstract
The "Oxford Rig" cadaveric simulator permits researchers and clinicians to study knee mechanics during a simulated squatting motion. The motion of the lower limb in the Oxford Rig is typically controlled by a single actuator that applies tension to the quadriceps tendon. The location of the quadriceps actuator, however, has differed across published descriptions of the Oxford Rig. Actuators have been placed on the femur and pelvis, and on "grounded" locations external to the specimen, but the consequences of this placement for knee kinematics and kinetics are unknown. The purpose of this study was to examine these effects using a validated computational musculoskeletal model. When the actuator was placed on the femur or pelvis, forces realistically increased with knee flexion, with quadriceps and patellofemoral contact forces exceeding 2000 N and 3000 N, respectively, at 100° flexion. When the actuator was grounded, however, forces were substantially reduced and did not monotonically increase with flexion. Articular joint contact forces were not strongly influenced by changing the location of the actuator from the femur to the pelvis, with small RMS differences in quadriceps forces (48.2 N), patellofemoral forces (83.6 N), and tibiofemoral forces (58.9 N) between these conditions. The location of the actuator did not substantially affect knee kinematics. The results of this study suggest that the quadriceps actuator of the Oxford Rig should be attached to either the femur or the pelvis when the goal is to make realistic estimates of quadriceps forces and articular contact forces within the knee joint.
Collapse
Affiliation(s)
- Michael W Hast
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Stephen J Piazza
- Biomechanics Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Mechanical and Nuclear Eng., The Pennsylvania State University, University Park, PA 16802, USA; Department of Orthopedics and Rehabilitation, The Pennsylvania State University, Hershey, PA 17033, USA
| |
Collapse
|
4
|
Maiti R, Cowie RM, Fisher J, Jennings LM. The influence of malalignment and ageing following sterilisation by gamma irradiation in an inert atmosphere on the wear of ultra-high-molecular-weight polyethylene in patellofemoral replacements. Proc Inst Mech Eng H 2017; 231:634-642. [PMID: 28661229 PMCID: PMC5495427 DOI: 10.1177/0954411917696112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications of patellofemoral arthroplasty often occur soon after implantation and, as well as other factors, can be due to the design of the implant or its surgical positioning. A number of studies have previously considered the wear of ultra-high-molecular-weight polyethylene patellae following suboptimal implantation; however, studies have primarily been carried out under a limited number of degrees of freedom. The aim of this study was to develop a protocol to assess the wear of patellae under a malaligned condition in a six-axis patellofemoral joint simulator. The malalignment protocol hindered the tracking of the patella centrally in the trochlear groove and imparted a constant 5° external rotation (tilt) on the patella button. Following 3 million cycles of wear simulation, this condition had no influence on the wear of ultra-high-molecular-weight polyethylene patellae aged for 4 years compared to well-positioned non-aged implants (p > 0.05). However, under the malaligned condition, ultra-high-molecular-weight polyethylene patellae aged 8-10 years after unpacking (following sterilisation by gamma irradiation in an inert atmosphere) and worn ultra-high-molecular-weight polyethylene components also aged 4 years after unpacking (following the same sterilisation process) exhibited a high rate of wear. Fatigue failure due to elevated contact stress led to delamination of the ultra-high-molecular-weight polyethylene and in some cases complete failure of the patellae. The results suggest that suboptimal tracking of the patella in the trochlear groove and tilt of the patella button could have a significant effect on the wear of ultra-high-molecular-weight polyethylene and could lead to implant failure.
Collapse
Affiliation(s)
- Raman Maiti
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Raelene M Cowie
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Yang CC, Dennis DA, Davenport PG, Kim RH, Miner TM, Johnson DR, Laz PJ. Patellar component design influences size selection and coverage. Knee 2017; 24:460-467. [PMID: 27916578 DOI: 10.1016/j.knee.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/27/2016] [Accepted: 10/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral (PF) complications following total knee arthroplasty continue to occur. Outcomes are influenced by implant design, size and alignment in addition to patient factors. The objective of this study was to assess the effect of implant design, specifically round versus oval dome patellar components, on size selected and bony coverage in a population of 100 patients. METHODS Intraoperative assessments of patella component size were performed using surgical guides for round and oval designs. Digital images of the resected patellae with and without guides were calibrated and analyzed to measure bony coverage. Lastly, the medial-lateral location of the median ridge was assessed in the native patella and compared to the positioning of the apex of the patellar implants. RESULTS In 82% of subjects, a larger oval implant was selected compared to a round. Modest, but statistically significant, differences were observed in selected component coverage of the resected patella: 82.7% for oval versus 80.9% for round. Further, positioning of the apex of oval patellar components reproduced the median ridge of the native patella more consistently than for round components. CONCLUSIONS These findings characterized how implant design influenced size selection and coverage in a population of patients. The ability to "upsize" with oval dome components led to increases in bony coverage and better replication of the median ridge compared to round components. Quantifying the interactions between implant design, sizing and coverage for a current implant system in a population of patients supports surgical decision-making and informs the design of future implants.
Collapse
Affiliation(s)
- Charlie C Yang
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA
| | - Douglas A Dennis
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA; Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Patrick G Davenport
- Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Raymond H Kim
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA; Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Todd M Miner
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA
| | - Derek R Johnson
- Denver-Vail Orthopedics, 8101 Lowry Blvd #260, Denver, CO 80230, USA
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA.
| |
Collapse
|
6
|
Keshmiri A, Maderbacher G, Baier C, Müller W, Grifka J, Springorum HR. Do surgical patellar interventions restore patellar kinematics in fixed-bearing, cruciate-retaining total knee arthroplasty?: An in vitro study. J Arthroplasty 2014; 29:2197-201. [PMID: 25108734 DOI: 10.1016/j.arth.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 02/01/2023] Open
Abstract
Despite different surgical patellar interventions, the decision how to treat the patella during TKA remains controversial. The purpose of this study was to quantify the effect of different reconstructive patellar interventions on patellar kinematics during TKA using optical computer navigation. We implanted ten navigated TKAs in full body specimens. During passive motion, the effect of different surgical patellar interventions on patellar kinematics was analysed. A contrarily tilt behaviour was observed in the TKA group without patellar intervention compared to the natural knee. Lateral release led to similar tilt values (P < 0.05). All surgical interventions led to a 3 to 5mm medial shift of the patella (P < 0.05). None of the analysed surgical patellar interventions could restore natural patellar kinematics after TKA.
Collapse
Affiliation(s)
- Armin Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Werner Müller
- Department of Orthopaedic Surgery, Cantonal Hospital Bruderholz, Bruderholz, Swiss
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | | |
Collapse
|
7
|
Maiti R, Fisher J, Rowley L, Jennings LM. The influence of kinematic conditions and design on the wear of patella-femoral replacements. Proc Inst Mech Eng H 2014; 228:175-81. [PMID: 24477888 PMCID: PMC4361355 DOI: 10.1177/0954411913518910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The success rate of patella-femoral arthroplasty varies between 44% and 90% in 17 years of follow-up. Several studies have been performed previously for assessing the surface wear in the patella-femoral joint. However, they have not included all six degrees of freedom. The aim of this study was to develop a six-axis patella-femoral joint simulator to assess the wear rate for two patellae designs (round and oval dome) at different kinematic conditions. An increase in patellar rotation from 1° to 4° led to a significantly (p<0.049) increased wear rate of round dome from 8.6 mm3/million cycles to 12.3 mm3/million cycles. The wear rate for oval dome increased from 6.3 mm3/million cycles to 14.5 mm3/million cycles. However, the increase was nonsignificant (p>0.08). The increase in wear rate was likely due to the higher cross shear. A decrease in patellar medial lateral displacement from passive to constrained resulted in a nonsignificant reduction in wear (p>0.06). There was no significant difference in wear rate between the two patellae designs (p>0.28). The volumetric wear under all conditions was positively correlated with the level of passive patellar tilt (rho>0.8). This is the first report of preclinical wear simulation of patella-femoral joint in a six-axis simulator under different kinematic conditions.
Collapse
Affiliation(s)
- Raman Maiti
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | | | | | | |
Collapse
|
8
|
Fitzpatrick CK, Kim RH, Ali AA, Smoger LM, Rullkoetter PJ. Effects of resection thickness on mechanics of resurfaced patellae. J Biomech 2013; 46:1568-75. [DOI: 10.1016/j.jbiomech.2013.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/10/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
|
9
|
Qiu YY, Yan CH, Chiu KY, Ng FY. Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong) 2012; 20:78-86. [PMID: 22535817 DOI: 10.1177/230949901202000116] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bone deficiency hinders implant alignment and stabilisation of the bone-implant interface in revision total knee arthroplasty (TKA). Treatments for bone defects include bone cement, bone cement with screw reinforcement, metal augments, impaction bone grafts, structural allografts, and tantalum, depending on the location and size of the defects. Small defects are usually treated with cement, cement plus screws, or impaction allograft bone. Large defects are repaired with structural allografts or metal augments. Recent developments involve the use of highly porous osteoconductive tantalum. We reviewed the pros and cons of each method for bone defect management in revision TKA.
Collapse
Affiliation(s)
- Yi Yan Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | | | | | | |
Collapse
|
10
|
Innocenti B, Pianigiani S, Labey L, Victor J, Bellemans J. Contact forces in several TKA designs during squatting: A numerical sensitivity analysis. J Biomech 2011; 44:1573-81. [PMID: 21435645 DOI: 10.1016/j.jbiomech.2011.02.081] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 11/17/2022]
Abstract
Total knee arthroplasty (TKA) is a very successful procedure, but pain or difficulties during activities still persist in patients. Patient outcomes in TKA surgery can be affected by implant design, alignment or patient-related anatomical factors. This paper presents a numerical sensitivity analysis of several TKA types: a fixed bearing, posterior stabilized prosthesis, a high flexion fixed bearing guided motion prosthesis, a mobile bearing prosthesis and a hinge prosthesis. Each prosthesis was virtually implanted on the same cadaver leg model and it underwent a loaded squat, in 10s, between 0° and 120°, similar to several previous experimental tests performed on knee kinematics simulators. The aim of this examination was to investigate the sensitivity of the patello-femoral (PF) and tibio-femoral (TF) contact forces to patient-related anatomical factors, and component position in the different implant types. The following parameters were used for the sensitivity study: the proximo-distal patellar position, the patellar component tilting, the tibial component position and orientation, the locations of the medial and lateral collateral ligaments with respect to femur and tibia and the patellar tendon length. The sensitivity analysis showed that PF contact forces are mostly affected by patella height (increases up to 67% for one TKA type in patella-alta configuration), by an anterior tibial component translation (increases up to 30%), and by patellar component tilting (increases up to 29%); TF contact forces are mostly affected by the anterior displacement of the insertion points of the medial collateral ligament with respect to the reference position (increases up to 48%).
Collapse
Affiliation(s)
- Bernardo Innocenti
- European Centre for Knee Research, Smith & Nephew, Technologielaan 11bis, 3300 Leuven, Belgium.
| | | | | | | | | |
Collapse
|
11
|
Di Martino A, Franceschi F, Papalia R, Marini M, Prossomariti G, Maffulli N, Denaro V. Increased bone mineral density in the non-resurfaced patella after total knee arthroplasty: a clinical and densitometric study. Surgeon 2011; 10:20-4. [PMID: 22233553 DOI: 10.1016/j.surge.2011.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 01/03/2011] [Indexed: 11/28/2022]
Abstract
We report the results of a longitudinal study of 40 patients with osteoarthritis who had primary prosthetic replacement without patellar resurfacing, and were followed at 6 months postoperatively with a densitometric study and clinically at a minimum follow-up of 2 years. Densitometric analysis showed a mean preoperative density at the affected knee of 0.69 g/cm(2) (CI: 0.62-0.76), compared to 0.86 g/cm(2) (CI: 0.79-0.93) for the opposite knee (p = 0.002). In our study population, the return to load and motion to the retained patella led to a significant increase in patellar bone density as measured by densitometry studies. This observation correlated with significant improvement in knee functional score.
Collapse
Affiliation(s)
- Alberto Di Martino
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
12
|
Williams DH, Masri BA, Garbuz DS. Porous Metal Augmentation of the Deficient Patella in Total Knee Replacement. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/btk.0b013e3181d16758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Catani F, Innocenti B, Belvedere C, Labey L, Ensini A, Leardini A. The Mark Coventry Award: Articular contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 2010; 468:19-28. [PMID: 19548042 PMCID: PMC2795837 DOI: 10.1007/s11999-009-0941-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 06/04/2009] [Indexed: 01/31/2023]
Abstract
In vivo fluoroscopy is a well-known technique to analyze joint kinematics of the replaced knee. With this method, however, the contact areas between femoral and tibial components, fundamental for monitoring wear and validating design concepts, are hard to identify. We developed and tested a novel technique to assess condylar and post-cam contacts in TKA. The technique uses in vivo motion data of the replaced knee from standard fluoroscopy as input for finite element models of the prosthesis components. In these models, tibiofemoral contact patterns at the condyles and post-cam articulations were calculated during various activities. To test for feasibility, the technique was applied to a bicruciate posterior-stabilized prosthesis. Sensitivity of the finite element analysis, validation of the technique, and in vivo tests were performed. To test for potential in the clinical setting, five patients were preliminarily analyzed during chair rising-sitting, stair climbing, and step up-down. For each task and patient, the condylar contact points and contact line rotation were calculated. The results were repeatable and consistent with corresponding calculations from traditional fluoroscopic analysis. Specifically, natural knee kinematics, which shows rolling back and screw home, seemed replicated in all motor tasks. Post-cam contact was observed on both the anterior and posterior faces. Anterior contact is limited to flexion angle close to extension; posterior contact occurs in deeper flexion but is dependent on the motor task. The data suggest the proposed technique provides reliable information to analyze post-cam contacts.
Collapse
Affiliation(s)
- Fabio Catani
- Department of Orthopedic Surgery, Istituto Ortopedici Rizzoli, Bologna, Italy
| | | | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto Ortopedici Rizzoli, Bologna, Italy
| | - Luc Labey
- European Center for Knee Research, Smith & Nephew, Leuven, Belgium
| | - Andrea Ensini
- Department of Orthopedic Surgery, Istituto Ortopedici Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedici Rizzoli, Bologna, Italy
| |
Collapse
|