A Mobile-bearing Knee Prosthesis Can Reduce Strain at the Proximal Tibia

Abstract

Mobile and fixed-bearing knee prostheses are likely to generate distinct strain gradients in the proximal tibia. The resulting strain distribution in the proximal tibia governs bone remodeling and affects implant integration and stability. We determined the effects of fixed and mobile-bearing total knee prostheses on strain distribution at the proximal tibia. This mobile-bearing prosthesis was evaluated in cadaveric specimens under axial and torsional loading. Strain on the proximal tibial cortex was measured with rosette strain gages and an optical full-field strain acquisition system. Tibial torsion in response to combined axial and torsional loading was documented. There was no difference in cortex strain between the fixed and the mobile-bearing prostheses under 1.5 kN axial loading. Superimposing 10 degrees tibial internal rotation induced 22% less compressive strain in the mobile-bearing prosthesis compared with the fixed-bearing prosthesis. Under 10 degrees tibial external rotation, the mobile-bearing prosthesis induced 33% less compressive strain than the fixed-bearing prosthesis. Optically acquired strain fields showed peak compressive strain at the anteromedial aspect 30 mm below the joint line. The mobile-bearing prosthesis reduced torque in the proximal tibia during knee rotation by 68-73% compared with the fixed-bearing prosthesis. Our data suggest that the particular mobile-bearing prosthesis tested potentially reduces elevated strain levels in the proximal tibia.