Abstract
Background
It is unclear how metal augments, polyethylene (PE) liner thickness, and length of cemented stem contribute to load transfer when reconstructing uncontained tibial metaphyseal bone loss of Anderson Orthopedic
Research Institute (AORI) Type II defects during revision total knee arthroplasty
(rTKA). The aim of this study is to understand the impact of these three variables on load transfer through the tibial baseplate. For a fixed defect depth, we hypothesized
that there is a particular combination of liner and augment thickness and stem length
that minimizes bone stress, reducing the risk of aseptic loosening.
Methods
We conducted a finite element analysis (FEA) to model stresses at the bone-cement
interface with different iterations of metal augments, PE liner thicknesses and fully-cemented stems lengths.
Results
For a 20 mm tibial defect, constructs with thicker metal augments and thinner polyethylene
liners were superior. Constructs with a fully cemented stem further reduced bone stress on the tibial plateau. Bone
stress was lowest when a 100 mm fully-cemented stem was used, while stems between
30 mm – 80 mm produced similar results.
Conclusions
When addressing a tibial bone defect of AORI Type II in rTKA, our FEA model demonstrates
that surgeons should opt to use the thickest metal augments in combination with a fully-cemented stem with an added length of at least 30 mm, which allows for surgical
flexibility together with the most stable construct. Our study is notably limited by lack of modeling of knee joint moments, which are
important when considering micromotion, bone-implant interface and stem effectiveness.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
November 26,
2022
Received in revised form:
November 20,
2022
Received:
April 12,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
