Medial tilting of the joint line in posterior stabilized total knee arthroplasty increases contact force and stress
Deutscher übersetzter Titel: | Die mediale Verkippung der Gelenklinie bei der posterior stabilisierten Knieendoprothetik erhöht die Kontaktkraft und die Belastung |
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Autor: | Tanaka, Yoshihisa; Nakamura, Shinichiro; Kuriyama, Shinichi; Nishitani, Kohei; Ito, Hiromu; Furu, Moritoshi; Watanabe, Mutsumi; Matsuda, Shuichi |
Erschienen in: | Clinical biomechanics |
Veröffentlicht: | 2018, 53, S. 54-59, Lit. |
Format: | Literatur (SPOLIT) |
Publikationstyp: | Zeitschriftenartikel |
Medienart: | Elektronische Ressource (online) Gedruckte Ressource |
Sprache: | Englisch |
ISSN: | 0268-0033, 1879-1271 |
DOI: | 10.1016/j.clinbiomech.2018.02.008 |
Schlagworte: | |
Online Zugang: | |
Erfassungsnummer: | PU201901000717 |
Quelle: | BISp |
Abstract des Autors
Background: Kinematically aligned total knee arthroplasty is based on the concept to represent the premorbid joint alignment with cruciate-retaining implants, characterized by medial tilt and internal rotation. However, kinematic and kinetic effects of kinematically aligned total knee arthroplasty with posterior-stabilized implants is unknown. The purpose of this study was to examine the effect of medial tilting of the joint line with posterior-stabilized implants.
Methods: A mechanical alignment model, and medial tilt 3° and 5° models were constructed. Knee kinematics and contact forces were simulated using a musculoskeletal computer simulation model. Contact stresses on the tibiofemoral joint and the post area were then calculated using finite element analysis.
Findings: From 0° to 120° of knee flexion, greater external rotation of the femoral component was observed in medial tilt models (−0.6°, 1.8° and 4.2° in mechanical alignment, medial tilt 3° and medial tilt 5° models, respectively). The peak contact stresses on the tibiofemoral joint and the post area at 120° of knee flexion were higher in medial tilt models. The peak contact stresses on the post area in medial tilt 3° and 5° models were 2.2 and 3.8 times greater than that in mechanical alignment model, respectively.
Interpretation: Medial tilting of the joint line causes greater axial rotation even with posterior-stabilized implants, which can represent near-normal kinematics. However, medial tilting of the joint line in total knee arthroplasty with posterior-stabilized implants may have a higher risk for polyethylene wear at the tibiofemoral joint and post area, leading to subsequent component loosening.