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Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study

  • Knee Revision Surgery
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Abstract

Introduction

No evidence-based guidelines are available to determine the appropriate stem length, and whether or not to cement stems in revision total knee arthroplasty (TKA). Therefore, the objective of this study was to compare stresses and relative movement of cemented and uncemented stems of different lengths using a finite element analysis.

Materials and methods

A finite element model was created for a synthetic tibia. Two stem lengths (95 and 160 mm) and two types of fixation (cemented or press fit) of a hinged TKA were examined. The average compressive stress distribution in different regions of interest, as well as implant micromotions, was determined and compared during lunge and squat motor tasks.

Results

Both long and short stems in revision TKA lead to high stresses, primarily in the region around the stem tip. The presence of cement reduces the stresses in the bone in every region along the stem. Short stem configurations are less affected by the presence of cement than the long stem configuration. Press-fit stems showed higher micromotions compared to cemented stems.

Conclusions

Lowest stresses and micromotion were found for long cemented stems. Cementless stems showed more micromotion and increased stress levels especially at the level of the stem tip, which may explain the clinical phenomenon of stem-end pain following revision knee arthroplasty. These findings will help the surgeon with optimal individual implant choice.

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Acknowledgments

The study was performed in the European Centre for Knee Research, Leuven, Belgium, and funded by Smith and Nephew.

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Authors and Affiliations

  1. Center of Orthopaedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35033, Marburg, Germany

    Bilal Farouk El-Zayat, Thomas J. Heyse & Susanne Fuchs-Winkelmann

  2. Department of Mechanics and Industrial Technology, University of Florence, Florence, Italy

    Nelson Fanciullacci

  3. Mechanical Engineering Technology TC, KU Leuven, Geel, Belgium

    Luc Labey

  4. BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Brussels, Belgium

    Bernardo Innocenti

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  1. Bilal Farouk El-Zayat
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  2. Thomas J. Heyse
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  3. Nelson Fanciullacci
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Correspondence to Bilal Farouk El-Zayat.

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Conflict of interest

There are no competing interests in relation to this study from: Nelson Fanciullacci. Bilal Farouk El-Zayat, Thomas J. Heyse and Susanne Fuchs-Winkelmann are paid consultants, speakers and instructors to Smith and Nephew and received research support. Luc Labey and Bernardo Innocenti are former paid employees to Smith and Nephew.

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El-Zayat, B.F., Heyse, T.J., Fanciullacci, N. et al. Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study. Arch Orthop Trauma Surg 136, 1741–1752 (2016). https://doi.org/10.1007/s00402-016-2571-0

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  • DOI: https://doi.org/10.1007/s00402-016-2571-0

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