DOI QR코드

DOI QR Code

Influence of Malalignment on Tibial Post in Total Knee Replacement Using Posterior Stabilized Implant

슬관절 전치환술에서 후방 안정 임플란트의 오정렬이 경골 기둥에 미치는 영향

  • Kim, Sang-Hoon (School of Advanced Technology, Kyung Hee University) ;
  • Ahn, Ok-Kyun (Department of Orthopedic Surgery, Kyung Hee Medical School) ;
  • Bae, Dae-Kyung (Department of Orthopedic Surgery, Kyung Hee Medical School) ;
  • Kim, Yoon-Hyuk (School of Advanced Technology, Kyung Hee University) ;
  • Kim, Kyung-Soo (Institute of Natural Sciences, Kyung Hee University) ;
  • Lee, Soon-Gul (School of Advanced Technology, Kyung Hee University)
  • 김상훈 (경희대학교 테크노공학대학) ;
  • 안옥균 (경희대학교 정형외과) ;
  • 배대경 (경희대학교 정형외과) ;
  • 김윤혁 (경희대학교 테크노공학대학) ;
  • 김경수 (경희대학교 자연과학종합연구) ;
  • 이순걸 (경희대학교 테크노공학대학)
  • Published : 2007.02.28

Abstract

Recently, it has been reported that the posterior stabilized implant, which is clinically used for the total knee replacement (TKR), may have failure risk such as wear or fracture by the contact pressure and stress on the tibial post. The purpose of this study is to investigate the influence of the mal alignment of the posterior stabilized implant on the tibial post by estimating the distributions of contact pressure and von-Mises stress on a tibial post and to analyze the failure risk of the tibial post. Finite element models of a knee joint and an implant were developed from 1mm slices of CT images and 3D CAD software, respectively. The contact pressure and the von-Mises stress applying on the implant were analyzed by the finite element analysis in the neutral alignment as well as the 8 malalignment cases (3 and 5 degrees of valgus and varus angulations, and 2 and 4 degrees of anterior and posterior tilts). Loading condition at the 40% of one whole gait cycle such as 2000N of compressive load, 25N of anterior-posterior load, and 6.5Nm of torque was applied to the TKR models. Both the maximum contact pressure and the maximum von-Mises stress were concentrated on the anterior-medial region of the tibial post regardless of the malalignment, and their magnitudes increased as the degree of the malalignment increased. From present result, it is shown that the malalignment of the implant can influence on the failure risk of the tibial post.

Keywords

References

  1. H.D. Clarke, K.R. Math, and G.R. Scuderi, 'Polyethylene post failure in posterior stabilized total knee arthroplasty,' Journal of Arthroplasty, vol. 19, pp. 652-657, 2004 https://doi.org/10.1016/j.arth.2004.02.026
  2. S. Matsuda, H. Miura, R. Nagamine, K. Urabe, K. Harimaya, T. Matsunobu, and Y. Iwamoto, 'Change in knee alignment after total knee arthroplasty,' Journal of Arthroplasty, vol.14,pp. 566-570, 1999 https://doi.org/10.1016/S0883-5403(99)90078-5
  3. J. Halloran P, A.J. Petrella, P.J. Rullkoetter, 'Explicit finite element modeling of total knee replacement mechanics,' Journal of Biom- echanics, vol. 38, pp. 323-331, 2005 https://doi.org/10.1016/j.jbiomech.2004.02.046
  4. Y.S. Chiu, W.M. Chen, C.K. Huang, C. Ching, and T.H, Chen, 'Fracture of the polyethylene tibial post in a NexGen posteriorstabilized knee prosthesis,' Journal of Arthroplasty, vol. 19, pp. 1045-1049, 2004 https://doi.org/10.1016/j.arth.2004.04.013
  5. G.H. van Lenthe, M.C. de Waal Malefijt, R. Huiskes, 'Stress shielding after total knee replacement may cause bone resorption in the distal femur,' Journal of Bone and Joint Surgery, vol. 79-b, pp. 117-122, 1997 https://doi.org/10.1302/0301-620X.79B1.0790117
  6. J.J. Liau, C.K. Cheng, C.H. Huang, W.H. Lo, 'The effect of malalignment on stresses in polyethylene component of total knee prostheses - a finite element analysis,' Clinical Biomechanics, vol. 17, pp. 140-146, 2002 https://doi.org/10.1016/S0268-0033(01)00109-7
  7. A. Perillo-Marcone, D.S. Barrett, and M. Taylor, 'The importance of tibial alignment - finite element analysis of tibial malalignment,' Journal of Arthroplasty, vol. 15, pp. 1020-1027, 2000 https://doi.org/10.1054/arth.2000.17941
  8. S.K.T. Puloski, R.W. McCalden, S.J. MacDonald, C.H. Rorabeck, and R.B. Bourne, 'Tibial post wear in posterior stabilized total knee arthroplasty : an unrecognized source of polyethylene debris,' Journal of Bone and Joint Surgery, vol. 83-a, pp. 390-397, 2001
  9. T. Villa, F. Migliavacca, D. Gastaldi, M. Colombo, R. Pietrabissa, 'Contact stresses and fatigue life in a knee prosthesis : comparison between in vitro measurements computational simulations,' Journal of Biomechanics, vol. 37, pp. 45-53, 2004 https://doi.org/10.1016/S0021-9290(03)00255-0
  10. M.J.K. Bankes, D.L. Back, S.R. Cannon, T.W.R. Briggs, 'The effect of component malalignment on the clinical and radiological outcome of the Kinemax total knee replacement,' Knee, vol. 10, pp. 55-60, 2003 https://doi.org/10.1016/S0968-0160(02)00050-9
  11. F.W. Werner, D.C. Ayers, L.P. Maletsky, and P.J. Rullkoetter, 'The effect of valgus/varus alignment on load distribution in total knee replacements,' Journal of Biomechanics, vol. 38, pp. 349- 355, 2005 https://doi.org/10.1016/j.jbiomech.2004.02.024
  12. J.J. Callaghan, M.R. O'Rourke, D.D. Goetz, T.P. Schmalzried, P.A. Campbell, R.C. Johnston, 'Tibial post impingement in posterior-stabilized total knee arthroplasty,' Clinical Orthopaedics and Related Research, vol. 404, pp. 83-88, 2002 https://doi.org/10.1097/00003086-200211000-00014
  13. R.C. Wasielewski, N. Parks, I. Williams, H. Surprenant, J.P. Collier, and G. Engh, 'Tibial insert undersurface as a contributing source of polyethylene wear debris,' Clinical Orthopaedics and Related Research, vol. 345, pp. 53-59, 1997
  14. W. Mesfar, A. Shirazi-Adl, 'Biomechanics of the knee joint in flexion under various quadriceps forces,' Knee, vol. 12, pp. 424- 434, 2005 https://doi.org/10.1016/j.knee.2005.03.004
  15. E. Pena, B. Calvo, M.A. Martinez, and M. Doblare, 'A threedimensional finite element analysis of the combined behavior of ligaments and menisci in the healthy human knee joint,' Journal of Biomechanics, vol. 39, pp. 1686-1701, 2006 https://doi.org/10.1016/j.jbiomech.2005.04.030
  16. P. Mestha, Y. Shenava, and D.A. John C, 'Fracture of the polyethylene tibial post in posterior stabilized (Insall Burstein II) total knee arthroplasty,' Journal of Arthroplasty, vol. 15, pp. 814-815, 2000 https://doi.org/10.1054/arth.2000.6615
  17. E.L. Feng, S.D. Stulberg, R.L. Wixson, 'Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces,' Clinical Orthopaedics and Related Research, vol. 299. pp. 60-71, 1994
  18. C.H. Huang, C.Y. Yang, C.K. Cheng, 'Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty - a case report,' Journal of Arthroplasty, vol. 14. pp. 375-379, 1999 https://doi.org/10.1016/S0883-5403(99)90066-9
  19. D.L. Bartel, J.J. Rawlinson, A.H. Burstein, C.S. Ranawat, W.F. Flynn, 'Stresses in polyethylene components of contemporary total knee replacements,' Clinical Orthopaedics and Related Research, vol. 317, pp. 76-82, 1995
  20. C.H. Huang, J.J. Liau, C.H. Huang, and C.K. Cheng, 'Influence of post-cam design on stresses on posterior-stabilized tibial posts,' Clinical Orthopaedics and Related Research, vol. 450, pp. 150- 156, 2006 https://doi.org/10.1097/01.blo.0000218739.76871.28
  21. G. Li, J. Gil, A. Kanamori, S.L.Y. Woo, 'A validated three- dimensional computational model of a human knee joint,' Journal of Biomechanical Engineering, vol. 121, pp. 657-662, 1999 https://doi.org/10.1115/1.2800871
  22. P.D. Postak, C.S. Heim, A.S. Greenwald, 'Tibial plateau surface stress in TKA : A factor influencing polymer damage series IV - PCL substituting design,' Orthopaedic Research Laboratories
  23. W.L. Sauer, K.D. Weaver and N.B. Beaks, 'Fatigue performance of ultra-high-molecular-weight polyethylene: effect of gamma radiation sterilization,' Biomeaterials, vol. 17, pp. 1929-1935, 1996 https://doi.org/10.1016/0142-9612(96)82602-0