Abstract
BackgroundIndividualized and accurate implantation of a tibial prosthesis during total knee arthroplasty (TKA) can assist in uniformly distributing the load and reducing the polyethylene wear to obtain a long-term prosthetic survival rate, but individualized and accurate implantation of a tibial prosthesis during TKA remains challenging. The purpose of this study was to optimize and individualize the positioning parameters of a tibial prosthesis to improve its accurate implantation using a new method of finite element analysis in combination with orthogonal experimental design.MethodsTen finite element models of TKA knee joint were developed to optimize the implantation parameters (varus angle, posterior slope angle, and external rotation angle) of tibial prosthesis to reduce the peak value of the contact pressure on the polyethylene liner according to the method of finite element analysis in combination with orthogonal experimental design. The influence of implantation parameters on the peak value of the contact pressure on the polyethylene liner was evaluated based on a range analysis in orthogonal experimental design.ResultsThe optimal implantation parameters for tibial prosthesis included 0° varus, 1° posterior slope, and 4° external rotation. Under these conditions, the peak value of the contact pressure on the polyethylene liner remained the smallest (16.37 MPa). Among the three parameters that affect the peak value of the contact pressure, the varus angle had the greatest effect (range = 6.70), followed by the posterior slope angle (range = 2.36), and the external rotation angle (range = 2.15).ConclusionsThe optimization method based on finite element analysis and orthogonal experimental design can guide the accurate implantation of the tibial prosthesis, reducing the peak value of the contact pressure on the polyethylene liner. This method provides new insights into the TKA preoperative plan and biomechanical decision-making for accurately implanting TKA prosthesis.
Highlights
Individualized and accurate implantation of a tibial prosthesis during total knee arthroplasty (TKA) can assist in uniformly distributing the load and reducing the polyethylene wear to obtain a long-term prosthetic survival rate, but individualized and accurate implantation of a tibial prosthesis during TKA remains challenging
The results revealed that the larger the tibial prosthesis varus angle was, the greater the peak value of the contact pressure on the polyethylene liner was, and the more likely wear of the polyethylene liners would occur [9]
The results showed that the peak value of the contact pressure on the polyethylene liner was 16.37 MPa, which was located in the medial compartment of the TKA knee
Summary
Individualized and accurate implantation of a tibial prosthesis during total knee arthroplasty (TKA) can assist in uniformly distributing the load and reducing the polyethylene wear to obtain a long-term prosthetic survival rate, but individualized and accurate implantation of a tibial prosthesis during TKA remains challenging. Individualized and accurate bone cuts and implantation of prosthetic components are considered as basic technical requirements of TKA, with the aim of restoring the neutral mechanical alignment of lower extremity, promoting uniform distribution of load in the knee joint, reducing wear of the polyethylene liner, and prolonging the survival of the TKA prosthesis [3, 4]. Accurate implantation of tibial prosthesis can effectively neutralize the mechanical alignment of the lower extremity. Owing to the relatively high frequency of tibial osteolysis, the uncertainty of tibial rotation references, and the significant influence of tibial prosthesis alignment on the load distribution in the knee joint, orthopedic surgeons have to pay special attention to the accuracy of tibial prosthesis implantation during TKA [4]
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