Finite element analysis of the tibial component stem orientation in revision total knee replacement

Benjamin Rastetter, Samantha Wright, Sabina Gheduzzi, Anthony Miles, Sally Clift

Research output: Contribution to conferenceAbstract

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Abstract

Background: Finite element (FE) models are frequently used in biomechanics to predict the behaviour of new implant designs.
To increase the stability after severe bone loss tibial components with long stems are used in revision total knee replacements
(TKR). A clinically reported complication after revision surgery is the occurrence of pain in the stem-end region. The aim of
this analysis was the development of a validated FE-model of a fully cemented implant and to evaluate the effect of different
tibial stem orientations.
Methods: A scanned 4th generation synthetic left tibia (Sawbones) was used to develop the FE-model with a virtually implanted
fully cemented tibial component. The 500 N load was applied with medial:lateral compartment distributions of 60:40 and 80:20.
Different stem positons were simulated by modifying the resection surface angle posterior to the tibias shaft axis. The results
were compared with an experimental study which used strain gauges on Sawbones tibias with an implanted tibial TKR
component. The locations of the experimental strain gauges were modelled in the FE study.
Results: Similar patterns and magnitudes of the predicted and experimentally measured strains were observed which validated
the FE-model. An increase of strain at the most distal gauge locations were measured with the stem-end in contact to the
posterior cortical bone. More uniform strain distributions were observed with the stem aligned to the intramedullary canal axis.
The load distribution of 80:20 shifts the strains to tensile laterally and a large increase of compressive strain in the medial
distal tibia.
Conclusions: A contributory factor of the clinically reported stem-end pain is possibly the direct effect of contact of the tibial
stem-end to the posterior region of the cortical bone. The increased load to the medial tibial compartment is more critical for
the development of pain.
Original languageEnglish
Publication statusPublished - Sep 2015
Event23rd Annual Meeting of the European Orthopaedic Research Society - Will's Memorial Building, Bristol, UK United Kingdom
Duration: 2 Sep 20154 Sep 2015

Conference

Conference23rd Annual Meeting of the European Orthopaedic Research Society
CountryUK United Kingdom
CityBristol
Period2/09/154/09/15

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Knee Replacement Arthroplasties
Finite Element Analysis
Tibia
Pain
Reoperation
Biomechanical Phenomena
Bone and Bones
Cortical Bone

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Rastetter, B., Wright, S., Gheduzzi, S., Miles, A., & Clift, S. (2015). Finite element analysis of the tibial component stem orientation in revision total knee replacement. Abstract from 23rd Annual Meeting of the European Orthopaedic Research Society, Bristol, UK United Kingdom.

Finite element analysis of the tibial component stem orientation in revision total knee replacement. / Rastetter, Benjamin; Wright, Samantha; Gheduzzi, Sabina; Miles, Anthony; Clift, Sally.

2015. Abstract from 23rd Annual Meeting of the European Orthopaedic Research Society, Bristol, UK United Kingdom.

Research output: Contribution to conferenceAbstract

Rastetter, B, Wright, S, Gheduzzi, S, Miles, A & Clift, S 2015, 'Finite element analysis of the tibial component stem orientation in revision total knee replacement' 23rd Annual Meeting of the European Orthopaedic Research Society, Bristol, UK United Kingdom, 2/09/15 - 4/09/15, .
Rastetter B, Wright S, Gheduzzi S, Miles A, Clift S. Finite element analysis of the tibial component stem orientation in revision total knee replacement. 2015. Abstract from 23rd Annual Meeting of the European Orthopaedic Research Society, Bristol, UK United Kingdom.
Rastetter, Benjamin ; Wright, Samantha ; Gheduzzi, Sabina ; Miles, Anthony ; Clift, Sally. / Finite element analysis of the tibial component stem orientation in revision total knee replacement. Abstract from 23rd Annual Meeting of the European Orthopaedic Research Society, Bristol, UK United Kingdom.
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abstract = "Background: Finite element (FE) models are frequently used in biomechanics to predict the behaviour of new implant designs.To increase the stability after severe bone loss tibial components with long stems are used in revision total knee replacements(TKR). A clinically reported complication after revision surgery is the occurrence of pain in the stem-end region. The aim ofthis analysis was the development of a validated FE-model of a fully cemented implant and to evaluate the effect of differenttibial stem orientations.Methods: A scanned 4th generation synthetic left tibia (Sawbones) was used to develop the FE-model with a virtually implantedfully cemented tibial component. The 500 N load was applied with medial:lateral compartment distributions of 60:40 and 80:20.Different stem positons were simulated by modifying the resection surface angle posterior to the tibias shaft axis. The resultswere compared with an experimental study which used strain gauges on Sawbones tibias with an implanted tibial TKRcomponent. The locations of the experimental strain gauges were modelled in the FE study.Results: Similar patterns and magnitudes of the predicted and experimentally measured strains were observed which validatedthe FE-model. An increase of strain at the most distal gauge locations were measured with the stem-end in contact to theposterior cortical bone. More uniform strain distributions were observed with the stem aligned to the intramedullary canal axis.The load distribution of 80:20 shifts the strains to tensile laterally and a large increase of compressive strain in the medialdistal tibia.Conclusions: A contributory factor of the clinically reported stem-end pain is possibly the direct effect of contact of the tibialstem-end to the posterior region of the cortical bone. The increased load to the medial tibial compartment is more critical forthe development of pain.",
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T1 - Finite element analysis of the tibial component stem orientation in revision total knee replacement

AU - Rastetter, Benjamin

AU - Wright, Samantha

AU - Gheduzzi, Sabina

AU - Miles, Anthony

AU - Clift, Sally

PY - 2015/9

Y1 - 2015/9

N2 - Background: Finite element (FE) models are frequently used in biomechanics to predict the behaviour of new implant designs.To increase the stability after severe bone loss tibial components with long stems are used in revision total knee replacements(TKR). A clinically reported complication after revision surgery is the occurrence of pain in the stem-end region. The aim ofthis analysis was the development of a validated FE-model of a fully cemented implant and to evaluate the effect of differenttibial stem orientations.Methods: A scanned 4th generation synthetic left tibia (Sawbones) was used to develop the FE-model with a virtually implantedfully cemented tibial component. The 500 N load was applied with medial:lateral compartment distributions of 60:40 and 80:20.Different stem positons were simulated by modifying the resection surface angle posterior to the tibias shaft axis. The resultswere compared with an experimental study which used strain gauges on Sawbones tibias with an implanted tibial TKRcomponent. The locations of the experimental strain gauges were modelled in the FE study.Results: Similar patterns and magnitudes of the predicted and experimentally measured strains were observed which validatedthe FE-model. An increase of strain at the most distal gauge locations were measured with the stem-end in contact to theposterior cortical bone. More uniform strain distributions were observed with the stem aligned to the intramedullary canal axis.The load distribution of 80:20 shifts the strains to tensile laterally and a large increase of compressive strain in the medialdistal tibia.Conclusions: A contributory factor of the clinically reported stem-end pain is possibly the direct effect of contact of the tibialstem-end to the posterior region of the cortical bone. The increased load to the medial tibial compartment is more critical forthe development of pain.

AB - Background: Finite element (FE) models are frequently used in biomechanics to predict the behaviour of new implant designs.To increase the stability after severe bone loss tibial components with long stems are used in revision total knee replacements(TKR). A clinically reported complication after revision surgery is the occurrence of pain in the stem-end region. The aim ofthis analysis was the development of a validated FE-model of a fully cemented implant and to evaluate the effect of differenttibial stem orientations.Methods: A scanned 4th generation synthetic left tibia (Sawbones) was used to develop the FE-model with a virtually implantedfully cemented tibial component. The 500 N load was applied with medial:lateral compartment distributions of 60:40 and 80:20.Different stem positons were simulated by modifying the resection surface angle posterior to the tibias shaft axis. The resultswere compared with an experimental study which used strain gauges on Sawbones tibias with an implanted tibial TKRcomponent. The locations of the experimental strain gauges were modelled in the FE study.Results: Similar patterns and magnitudes of the predicted and experimentally measured strains were observed which validatedthe FE-model. An increase of strain at the most distal gauge locations were measured with the stem-end in contact to theposterior cortical bone. More uniform strain distributions were observed with the stem aligned to the intramedullary canal axis.The load distribution of 80:20 shifts the strains to tensile laterally and a large increase of compressive strain in the medialdistal tibia.Conclusions: A contributory factor of the clinically reported stem-end pain is possibly the direct effect of contact of the tibialstem-end to the posterior region of the cortical bone. The increased load to the medial tibial compartment is more critical forthe development of pain.

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