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. 2019 Apr 2;8(3):156-164.
doi: 10.1302/2046-3758.83.BJR-2018-0193.R1. eCollection 2019 Mar.

Influence of Tibiofemoral Congruency Design on the Wear of Patient-Specific Unicompartmental Knee Arthroplasty Using Finite Element Analysis

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Free PMC article

Influence of Tibiofemoral Congruency Design on the Wear of Patient-Specific Unicompartmental Knee Arthroplasty Using Finite Element Analysis

Y-G Koh et al. Bone Joint Res. .
Free PMC article

Abstract

Objectives: Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patients. To satisfy this requirement, new patient-specific prosthetic designs have been introduced. The patient-specific UKA is designed on the basis of data from preoperative medical images. In general, knee implant design with increased conformity has been developed to provide lower contact stress and reduced wear on the tibial insert compared with flat knee designs. The different tibiofemoral conformity may provide designers the opportunity to address both wear and kinematic design goals simultaneously. The aim of this study was to evaluate wear prediction with respect to tibiofemoral conformity design in patient-specific UKA under gait loading conditions by using a previously validated computational wear method.

Methods: Three designs with different conformities were developed with the same femoral component: a flat design normally used in fixed-bearing UKA, a tibia plateau anatomy mimetic (AM) design, and an increased conforming design. We investigated the kinematics, contact stress, contact area, wear rate, and volumetric wear of the three different tibial insert designs.

Results: Conforming increased design showed a lower contact stress and increased contact area. In addition, increased conformity resulted in a reduction of the wear rate and volumetric wear. However, the increased conformity design showed limited kinematics.

Conclusion: Our results indicated that increased conformity provided improvements in wear but resulted in limited kinematics. Therefore, increased conformity should be avoided in fixed-bearing patient-specific UKA design. We recommend a flat or plateau AM tibial insert design in patient-specific UKA.Cite this article: Y-G. Koh, K-M. Park, H-Y. Lee, K-T. Kang. Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis. Bone Joint Res 2019;8:156-164. DOI: 10.1302/2046-3758.83.BJR-2018-0193.R1.

Keywords: Conformity; Patient-specific implant; Unicompartmental knee arthroplasty; Wear.

Figures

Fig. 1
Fig. 1
Development of the patient-specific unicompartmental knee arthroplasty (UKA) model based on using the patient’s CT and MRI images: a) femoral component; b) tibial component.
Fig. 2
Fig. 2
3D model and cross section of the three different tibial inserts: nonconforming (NC) unicompartmental knee arthroplasty (UKA), anatomy mimetic (AM)-UKA, and conforming (C)-UKA.
Fig. 3
Fig. 3
Wear prediction finite element (FE) model of unicompartmental knee arthroplasty (UKA) and loading condition used in this study. AP, anteroposterior; IE, internal-external.
Fig. 4
Fig. 4
Input function for finite element (FE) model based on the ISO gait cycle: a) axial load; b) flexion angle; c) anteroposterior (AP) force; and d) internal-external (IE) torque.
Fig. 5
Fig. 5
Kinematic ranges of anteroposterior (AP) displacement and internal-external (IE) rotation for the three different tibial insert designs under the gait cycle over five million cycles. NC, nonconforming; AM, anatomy mimetic; C, conforming; UKA, unicompartmental knee arthroplasty.
Fig. 6
Fig. 6
Comparison of the contact stress and contact area for the three different tibial insert designs under the gait cycle over five million cycles. NC, nonconforming; AM, anatomy mimetic; C, conforming; UKA, unicompartmental knee arthroplasty.
Fig. 7
Fig. 7
Predicted wear contour of the three different tibial insert designs under gait cycle loading: a) nonconforming unicompartmental knee arthroplasty (UKA); b) anatomy mimetic UKA; and c) conforming UKA.

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