Stem to prevent periprosthetic fracture after notching in total knee arthroplasty

IF 2.2 4区 医学 Q3 ENGINEERING, BIOMEDICAL
Qian Wan, Aobo Zhang, Yang Liu, Hao Chen, Xue Zhao, Qing Han, Jincheng Wang
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Abstract

Improper osteotomy during total knee arthroplasty (TKA) can lead to anterior femoral notching, which increases the risk of periprosthetic fractures due to stress concentration. One potential solution is the addition of an intramedullary stem to the femoral component. However, the optimal stem length remains unclear. In this study, we aimed to determine the optimal stem length using finite element models. Finite element models of femurs were developed with unstemmed prostheses and prostheses with stem lengths of 50, 75, and 100 mm. Under squat loading conditions, the von Mises stress at the notch and stress distribution on four transversal sections of the femur were analyzed. Additionally, micromotion of the prosthesis–bone interface was evaluated to assess initial stability. The unstemmed prosthesis exhibited a von Mises stress of 191.8 MPa at the notch, which decreased to 43.1, 8.8, and 23.5 MPa for stem lengths of 50, 75, and 100 mm, respectively. The stress reduction on four selected femoral transversal sections compared with the unstemmed prosthesis was 40.0%, 84.4%, and 67.1% for stem lengths of 50, 75, and 100 mm, respectively. Micromotion analysis showed a maximum of 118.8 μm for the unstemmed prosthesis, which decreased significantly with the application of stems, particularly at the anterior flange. Intramedullary stems effectively reduced stress concentration at the femoral notch. The 50-mm stem length provided the optimal combination of reduced notch stress, minimized stress-shielding effect, and decreased micromotion at the anterior flange.

Abstract Image

防止全膝关节置换术切口后假体周围骨折的茎。
全膝关节置换术(TKA)中不适当的截骨会导致股骨前切口,应力集中会增加假体周围骨折的风险。一种潜在的解决方案是在股骨组件中添加髓内骨干。然而,最佳髓内干长度仍不明确。在这项研究中,我们旨在利用有限元模型确定最佳的骨干长度。我们建立了无柄假体和柄长为50、75和100毫米的假体的股骨有限元模型。在下蹲加载条件下,分析了切口处的冯米斯应力和股骨四个横向截面上的应力分布。此外,还对假体-骨界面的微动进行了评估,以评估初始稳定性。无茎假体缺口处的冯米斯应力为191.8兆帕,当茎长度为50、75和100毫米时,应力分别降至43.1、8.8和23.5兆帕。股骨柄长度为 50、75 和 100 毫米时,与无柄假体相比,四个选定股骨横切面的应力降低率分别为 40.0%、84.4% 和 67.1%。微动分析表明,无茎假体的最大微动量为 118.8 μm,使用茎杆后,微动量明显减少,尤其是在前缘。髓内柄有效地减少了股骨凹口处的应力集中。髓内柄长度为50毫米,是减少切口应力、应力屏蔽效应最小化和减少前缘微动的最佳组合。
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来源期刊
International Journal for Numerical Methods in Biomedical Engineering
International Journal for Numerical Methods in Biomedical Engineering ENGINEERING, BIOMEDICAL-MATHEMATICAL & COMPUTATIONAL BIOLOGY
CiteScore
4.50
自引率
9.50%
发文量
103
审稿时长
3 months
期刊介绍: All differential equation based models for biomedical applications and their novel solutions (using either established numerical methods such as finite difference, finite element and finite volume methods or new numerical methods) are within the scope of this journal. Manuscripts with experimental and analytical themes are also welcome if a component of the paper deals with numerical methods. Special cases that may not involve differential equations such as image processing, meshing and artificial intelligence are within the scope. Any research that is broadly linked to the wellbeing of the human body, either directly or indirectly, is also within the scope of this journal.
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