Abstract
Background The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. Method Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with cement were generated. Contact stresses on the surface of cancellous bone in different areas were calculated. Results Compared to the cement-only technique, the stress on the border of cancellous bone and bone cement decreased by 10% using the screw and cement technique. For bone defects with a 12% defect area and a 12-mm defect depth, the use of 1 screw achieved the greatest stability; for those with a 15% defect area and a 20-mm defect depth, 2 screws achieved the greatest stability. Conclusions (1) The screw and cement technique is superior to the bone cement-only technique. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better.
Highlights
Medial tibial plateau defects can often be found in primary total knee arthroplasty (TKA) and require additional management to ensure implant stabilization, support, and durability
In previous studies, the number and insertion angle of screws were chosen based on personal experience, to fill a given medial tibial defect, previous authors have used as many screws as possible to ensure the stability of the tibial prosthesis [14,15,16,17,18], and no published study has determined the optimal number of screws or whether differences exist between the two different frequently used screw insertion angles
In models with a 12% defect area and a 12-mm depth, the use of 1 vertical screw to rebuild the defect resulted in a lower focused stress (1.05 MPa) than the stress found with the use of 1 oblique screw (1.23 MPa)
Summary
Medial tibial plateau defects can often be found in primary total knee arthroplasty (TKA) and require additional management to ensure implant stabilization, support, and durability. The purpose of this study was to perform a finite element (FE) assessment to determine the effect of different numbers of screws on the stability of TKA for two types of moderate uncontained type-2 defects and to determine whether differences exist between two different screw insertion angles. The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better
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