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Finite element analysis of biomechanical effects of residual varus/valgus malunion after femoral fracture on knee joint

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Abstract

Objective

Post-operative femoral shaft fractures are often accompanied by a residual varus/valgus deformity, which can result in osteoarthritis in severe cases. The purpose of this study was to investigate the biomechanical effects of residual varus/valgus deformities after middle and lower femoral fracture on the stress distribution and contact area of knee joint.

Methods

Thin-slice CT scanning of lower extremities and MRI imaging of knee joints were obtained from a healthy adult male to establish normal lower limb model (neutral position). Then, the models of 3°, 5°, and 10° of varus/valgus were established respectively by modifying middle and lower femur of normal model. To validate the modifying, a patient-specific model, whose BMI was same to former and had 10° of varus deformity of tibia, was built and simulated under the same boundary conditions.

Result

The contact area and maximum stress of modified models were similar to those of patient-specific model. The contact area and maximum stress of medial tibial cartilage in normal neutral position were 244.36 mm2 and 0.64 MPa, while those of lateral were 196.25 mm2 and 0.76 MPa. From 10° of valgus neutral position to 10° of varus, the contact area and maximum stress of medial tibial cartilage increased, and the lateral gradually decreased. The contact area and maximum stress of medial meniscus in normal neutral position were 110.91 mm2 and 3.24 MPa, while those of lateral were 135.83 mm2 and 3.45 MPa. The maximum stress of medial tibia subchondral bone in normal neutral position was 1.47 MPa, while that of lateral was 0.65 MPa. The variation trend of medial/lateral meniscus and subchondral bone was consistent with that of tibial plateau cartilage in the contact area and maximum stress.

Conclusion

This study suggested that varus/valgus deformity of femur had an obvious effect on the contact area and stress distribution of knee joint, providing biomechanical evidence and deepening understanding when performing orthopedic trauma surgery or surgical correction of the already existing varus/valgus deformity.

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Funding

This study was supported by the Support Program for the National Natural Science Foundation of China (Grant No. 82072447, 81401789) and the Hebei National Science Foundation-Outstanding Youth Foundation (Grant No. H2017206104). The funding source has no role in study design, conduction, data collection, or statistical analysis.

Author information

Author notes

  1. Kai Ding, Weijie Yang and Haicheng Wang contributed equally to this work.

Authors and Affiliations

  1. Trauma Emergency Center, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People’s Republic of China

    Kai Ding, Weijie Yang, Haicheng Wang, Pan Hu, Junsheng Bai, Chuan Ren, Qi Zhang, Yanbin Zhu & Wei Chen

  2. Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Kai Ding, Weijie Yang, Haicheng Wang, Pan Hu, Junsheng Bai, Chuan Ren, Qi Zhang, Yanbin Zhu & Wei Chen

  3. Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Xuhui District, Shanghai, 200233, People’s Republic of China

    Shi Zhan

  4. NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People’s Republic of China

    Wei Chen

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  1. Kai Ding
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Contributions

W. C. and Y. Z. designed the study. W. C. and Y.Z. searched relevant studies. K. D., W. Y., S. Z., C. R., Y. B., Q. Z., and P.H. analyzed and interpreted the data. K. D., W. Y., and H. W. wrote the manuscript and contributed equally to this work. W. C., Y. Z., and S.Z. contributed most in the revision of this manuscript. All authors approved the final version of the manuscript.

Corresponding authors

Correspondence to Yanbin Zhu or Wei Chen.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study conforms to the provisions of the Declaration of Helsinki and has been reviewed and approved by the Institutional Review Board of The Third Hospital of Hebei Medical University.

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Informed consent to participate and publish was obtained from the volunteer individual in the study.

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Ding, K., Yang, W., Wang, H. et al. Finite element analysis of biomechanical effects of residual varus/valgus malunion after femoral fracture on knee joint. International Orthopaedics (SICOT) 45, 1827–1835 (2021). https://doi.org/10.1007/s00264-021-05039-9

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