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Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

We previously combined experimental and computational measures to ascertain whether tibial stem augmentation reduces bone strains beneath constrained condylar implants. Using these same integrated approaches, we examined the benefit of a stem when a wedge is used. Implants were removed from the eight paired cadaver specimens from our previous experiment, and oblique defects created that were restored with 15° metallic wedges cemented in place. We applied a varus moment and an axial load and monitored relative motion between implant and bone. Specimen-specific 3-D finite element models were constructed from CT scans and radiographs to examine bone stress in the proximal tibia. Implants with a wedge but no stem had greater motion than the previous control with no stem or wedge. Use of a modular stem with a wedge maintained the same level of motion as the primary case, suggesting that a stem is preferable when a wedge is utilized. The computational models confirmed this conclusion with a 30% reduction in bone stress compared to 17% in the primary case without a wedge. The wedge carried more axial load compared to the primary implant due to its support on stiff metaphyseal bone.

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Authors and Affiliations

  1. Cornell University, Ithaca, NY, USA

    Jeremy J. Rawlinson PhD

  2. Ocean Orthopedic Associates, 530 Lakehurst Road, Tom’s River, NJ, 08755, USA

    Robert F. Closkey Jr MD

  3. Hospital for Special Surgery, New York, NY, USA

    Nicole Davis, Timothy M. Wright PhD & Russell Windsor MD

Authors
  1. Jeremy J. Rawlinson PhD
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  2. Robert F. Closkey Jr MD
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  3. Nicole Davis
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  4. Timothy M. Wright PhD
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  5. Russell Windsor MD
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Corresponding author

Correspondence to Robert F. Closkey Jr MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The Clark and Kirby Foundations provided financial support.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Rawlinson, J.J., Closkey, R.F., Davis, N. et al. Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees. Clin Orthop Relat Res 466, 2639–2643 (2008). https://doi.org/10.1007/s11999-008-0424-z

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  • DOI: https://doi.org/10.1007/s11999-008-0424-z

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