Biomechanical effect of anatomical tibial component design on load distribution of medial proximal tibial bone in total knee arthroplasty : finite element analysis indicating anatomical design prevents stress-shielding

Byung W Cho; Kyoung-Tak Kang; Hyuck M Kwon; Woo-Suk Lee; Ick H Yang; Ji H Nam; Yong-Gon Koh; Kwan K Park

doi:10.1302/2046-3758.115.BJR-2021-0537.R1

Biomechanical effect of anatomical tibial component design on load distribution of medial proximal tibial bone in total knee arthroplasty : finite element analysis indicating anatomical design prevents stress-shielding

Bone Joint Res. 2022 May;11(5):252-259. doi: 10.1302/2046-3758.115.BJR-2021-0537.R1.

Authors

Byung W Cho¹, Kyoung-Tak Kang², Hyuck M Kwon¹, Woo-Suk Lee¹, Ick H Yang³, Ji H Nam², Yong-Gon Koh⁴, Kwan K Park³

Affiliations

¹ Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
² Department of Mechanical Engineering, Yonsei University, Seoul, South Korea.
³ Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.

PMID: 35491552
PMCID: PMC9130674
DOI: 10.1302/2046-3758.115.BJR-2021-0537.R1

Abstract

Aims: This study aimed to identify the effect of anatomical tibial component (ATC) design on load distribution in the periprosthetic tibial bone of Koreans using finite element analysis (FEA).

Methods: 3D finite element models of 30 tibiae in Korean women were created. A symmetric tibial component (STC, NexGen LPS-Flex) and an ATC (Persona) were used in surgical simulation. We compared the FEA measurements (von Mises stress and principal strains) around the stem tip and in the medial half of the proximal tibial bone, as well as the distance from the distal stem tip to the shortest anteromedial cortical bone. Correlations between this distance and FEA measurements were then analyzed.

Results: The distance from the distal stem tip to the shortest cortical bone showed no statistically significant difference between implants. However, the peak von Mises stress around the distal stem tip was higher with STC than with ATC. In the medial half of the proximal tibial bone: 1) the mean von Mises stress, maximum principal strain, and minimum principal strain were higher with ATC; 2) ATC showed a positive correlation between the distance and mean von Mises stress; 3) ATC showed a negative correlation between the distance and mean minimum principal strain; and 4) STC showed no correlation between the distance and mean measurements.

Conclusion: Implant design affects the load distribution on the periprosthetic tibial bone, and ATC can be more advantageous in preventing stress-shielding than STC. However, under certain circumstances with short distances, the advantage of ATC may be offset. Cite this article: Bone Joint Res 2022;11(5):252-259.

Keywords: Anatomical tibial component; Finite element analysis; Medial proximal tibial bone loss; Pearson correlation; Stress-shielding; Total knee arthroplasty; Total knee arthroplasty (TKA); anatomical tibial component; cancellous bone; cortical bone; finite element analysis; finite element models; strains; tibial bone; tibial components.