Finite element analysis of the effect of knee movable unicompartmental prosthesis insertion shape and mounting position on stress distribution in the knee joint after replacement_Journal of Biomedical Engineering

Authors：

ZHAO Mingxin ¹ ,  GUO Yuan ¹ , WANG Changjiang ² , ZHANG Xushu ¹ , JI Binping ³ , ZHANG Kai ³ , HE Dongdong ¹

1. College of Biomedical Engineering, Taiyuan University of Technology, Jinzhong, Shanxi 030600, P. R. China;
2. University of Sussex, Brighton, BN1 9RH, UK;
3. Shanxi HuaJin orthopaedic hospital, Taiyuan 030400, P. R. China;

Corresponding author：

GUO Yuan, Email: guoyuan@tyut.edu.cn

Keywords：

Unicompartmental knee replacement; Replacement position; Insert; Prosthesis; Finite element analysis

DOI：

10.7507/1001-5515.202202007

Video：

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In unicompartmental replacement surgery, there are a wide variety of commercially available unicompartmental prostheses, and the consistency of the contact surface between the common liner and the femoral prosthesis could impact the stress distribution in the knee after replacement in different ways. Medial tibial plateau fracture and liner dislocation are two common forms of failure after unicompartmental replacement. One of the reasons is the mismatch in the mounting position of the unicompartmental prosthesis in the knee joint, which may lead to failure. Therefore, this paper focuses on the influence of the shape of the contact surface between the liner and the femoral prosthesis and the mounting position of the unicompartmental prosthesis on the stress distribution in the knee joint after replacement. Firstly, a finite element model of the normal human knee joint was established, and the validity of the model was verified by both stress and displacement. Secondly, two different shapes of padded knee prosthesis models (type A and type B) were developed to simulate and analyze the stress distribution in the knee joint under single-leg stance with five internal or external rotation mounting positions of the two pads. The results showed that under a 1 kN axial load, the peak contact pressure of the liner, the peak ACL equivalent force, and the peak contact pressure of the lateral meniscus were smaller for type A than for type B. The liner displacement, peak contact pressure of the liner, peak tibial equivalent force, and peak ACL equivalent force were the smallest for type A at 3° of internal rotation in all five internal or external rotation mounting positions. For unicompartmental replacement, it is recommended that the choice of type A or type B liner for prosthetic internal rotation up to 6° should be combined with other factors of the patient for comprehensive analysis. In conclusion, the results of this paper may reduce the risk of liner dislocation and medial tibial plateau fracture after unicompartmental replacement, providing a biomechanical reference for unicompartmental prosthesis design.

Citation： ZHAO Mingxin, GUO Yuan, WANG Changjiang, ZHANG Xushu, JI Binping, ZHANG Kai, HE Dongdong. Finite element analysis of the effect of knee movable unicompartmental prosthesis insertion shape and mounting position on stress distribution in the knee joint after replacement. Journal of Biomedical Engineering, 2022, 39(4): 660-671. doi: 10.7507/1001-5515.202202007 Copy

1.	Gill J R, Corbett J A, Wastnedge E, et al. Forgotten joint score: comparison between total and unicompartmental knee arthroplasty. The Knee, 2021, 29: 26-32.
2.	Halawi M J, Barsoum W K. Unicompartmental knee arthroplasty: key concepts. J Clin Orthop Trauma, 2017, 8(1): 11-13.
3.	Peersman G, Jak W, Vandenlangenbergh T, et al. Cost-effectiveness of unicompartmental versus total knee arthroplasty: a Markov model analysis. The Knee, 2014, 21(Suppl 1): S37-S42.
4.	贾笛, 李彦林, 杨龄坚, 等. 单髁置换术后膝关节内外侧间室应力变化有限元分析. 中国运动医学杂志, 2017, 36(10): 852-857.
5.	Lustig S, Lording T, Frank F, et al. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. The Knee, 2014, 21(1): S26-S32.
6.	Murray D W, Goodfellow J W, O'connor J J. The oxford medial unicompartmental arthroplasty: a ten-year survival study. The Journal of bone and joint surgery British volume, 1998, 80(6): 983-989.
7.	Christensen N O. Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop Relat Res, 1991, 1991(273): 165-169.
8.	Heck D A, Marmor L, Gibson A, et al. Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. Clin Orthop Relat Res, 1993(286): 154-159.
9.	Insall J, Aglietti P. A five to seven-year follow-up of unicompartmental arthroplasty. J Bone Joint Surg Am, 1980, 62(8): 1329-1337.
10.	Laskin R S. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am, 1978, 60(2): 182-185.
11.	Kang K T, Son J, Koh Y G, et al. Effect of femoral component position on biomechanical outcomes of unicompartmental knee arthroplasty. The Knee, 2018, 25(3): 491-498.
12.	Nie Y, Yu Q, Shen B. Impact of tibial component coronal alignment on knee joint biomechanics following fixed-bearing unicompartmental knee arthroplasty: a finite element analysis. Orthop Surg, 2021, 13(4): 1423-1429.
13.	Inoue S, Akagi M, Asada S, et al. The valgus inclination of the tibial component increases the risk of medial tibial condylar fractures in unicompartmental knee arthroplasty. J Arthroplasty, 2016, 31(9): 2025-2030.
14.	Newman J H, Ackroyd C E, Shah N A. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br, 1998, 80(5): 862-865.
15.	Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res, 2004(423): 161-165.
16.	Endo M M, Barbour P S, Barton D C, et al. Comparative wear and wear debris under three different counterface conditions of crosslinked and non-crosslinked ultra high molecular weight polyethylene. Biomed Mater Eng, 2001, 11(1): 23-35.
17.	Fisher J, Mcewen H M, Tipper J L, et al. Wear, debris, and biologic activity of cross-linked polyethylene in the knee: benefits and potential concerns. Clin Orthop Relat Res, 2004(428): 114-119.
18.	Kang K T, Son J, Kwon S K, et al. Preservation of femoral and tibial coronal alignment to improve biomechanical effects of medial unicompartment knee arthroplasty: computational study. Biomed Mater Eng, 2018, 29(5): 651-664.
19.	Zhu G D, Guo W S, Zhang Q D, et al. Finite element analysis of mobile-bearing unicompartmental knee arthroplasty: the influence of tibial component coronal alignment. Chin Med J, 2015, 128(21): 2873-2878.
20.	Bao H R C, Zhu D, Gong H, et al. The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis. Journal of Orthopaedic Science, 2013, 18(2): 256-263.s.
21.	Rho J Y, Hobatho M C, Ashman R B. Relations of mechanical properties to density and CT numbers in human bone. Med Eng Phys, 1995, 17(5): 347-355.
22.	张国栋, 廖维靖, 陶圣祥, 等. 股骨有限元分析赋材料属性的方法. 中国组织工程研究与临床康复, 2009, 13(43): 8436-8441.
23.	鲍春雨, 郭宝川, 孟庆华. 人体膝关节有限元模型建立及其有效性验证. 应用力学学报, 2017, 34(3): 559-563, 615.
24.	李新宇. 一种新型人工膝关节置换假体的设计及力学评估. 太原: 太原理工大学, 2017.
25.	Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res, 1980(149): 283-290.
26.	Peña E, Martínez M A, Calvo B, et al. A finite element simulation of the effect of graft stiffness and graft tensioning in ACL reconstruction. Clin Biomech (Bristol, Avon), 2005, 20(6): 636-644.
27.	朱广铎, 郭万首, 程立明, 等. 活动平台单髁膝关节置换胫骨后倾的有限元分析. 中国组织工程研究, 2015, 019(44): 7156-7162.
28.	Cossey A J, Spriggins A J. The use of computer-assisted surgical navigation to prevent malalignment in unicompartmental knee arthroplasty. J Arthroplasty, 2005, 20(1): 29-34.
29.	Pegg E C, Walter J, Mellon S J, et al. Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement. Journal of Orthopaedic Research, 2013, 31(5): 821-828.
30.	Aleto T J, Berend M E, Ritter M A, et al. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty, 2008, 23(2): 159-163.
31.	Marmor L. Unicompartmental knee arthroplasty. ten- to 13-year follow-up study. Clin Orthop Relat Res, 1988(226): 14-20.
32.	Innocenti B, Bilgen Ö F, Labey L, et al. Load sharing and ligament strains in balanced, overstuffed and understuffed UKA. a validated finite element analysis. J Arthroplasty, 2014, 29(7): 1491-1498.
33.	Emerson R J, Higgins L L. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am, 2008, 90(1): 118-122.
34.	Gulati A, Chau R, Simpson D J, et al. Influence of component alignment on outcome for unicompartmental knee replacement. The Knee, 2009, 16(3): 196-199.
35.	Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am, 2004, 86(3): 506-511.
36.	Weber P, Schröder C, Schmidutz F, et al. Increase of tibial slope reduces backside wear in medial mobile bearing unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon), 2013, 28(8): 904-909.

1. Gill J R, Corbett J A, Wastnedge E, et al. Forgotten joint score: comparison between total and unicompartmental knee arthroplasty. The Knee, 2021, 29: 26-32.
2. Halawi M J, Barsoum W K. Unicompartmental knee arthroplasty: key concepts. J Clin Orthop Trauma, 2017, 8(1): 11-13.
3. Peersman G, Jak W, Vandenlangenbergh T, et al. Cost-effectiveness of unicompartmental versus total knee arthroplasty: a Markov model analysis. The Knee, 2014, 21(Suppl 1): S37-S42.
4. 贾笛, 李彦林, 杨龄坚, 等. 单髁置换术后膝关节内外侧间室应力变化有限元分析. 中国运动医学杂志, 2017, 36(10): 852-857.
5. Lustig S, Lording T, Frank F, et al. Progression of medial osteoarthritis and long term results of lateral unicompartmental arthroplasty: 10 to 18 year follow-up of 54 consecutive implants. The Knee, 2014, 21(1): S26-S32.
6. Murray D W, Goodfellow J W, O'connor J J. The oxford medial unicompartmental arthroplasty: a ten-year survival study. The Journal of bone and joint surgery British volume, 1998, 80(6): 983-989.
7. Christensen N O. Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop Relat Res, 1991, 1991(273): 165-169.
8. Heck D A, Marmor L, Gibson A, et al. Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. Clin Orthop Relat Res, 1993(286): 154-159.
9. Insall J, Aglietti P. A five to seven-year follow-up of unicompartmental arthroplasty. J Bone Joint Surg Am, 1980, 62(8): 1329-1337.
10. Laskin R S. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am, 1978, 60(2): 182-185.
11. Kang K T, Son J, Koh Y G, et al. Effect of femoral component position on biomechanical outcomes of unicompartmental knee arthroplasty. The Knee, 2018, 25(3): 491-498.
12. Nie Y, Yu Q, Shen B. Impact of tibial component coronal alignment on knee joint biomechanics following fixed-bearing unicompartmental knee arthroplasty: a finite element analysis. Orthop Surg, 2021, 13(4): 1423-1429.
13. Inoue S, Akagi M, Asada S, et al. The valgus inclination of the tibial component increases the risk of medial tibial condylar fractures in unicompartmental knee arthroplasty. J Arthroplasty, 2016, 31(9): 2025-2030.
14. Newman J H, Ackroyd C E, Shah N A. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br, 1998, 80(5): 862-865.
15. Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res, 2004(423): 161-165.
16. Endo M M, Barbour P S, Barton D C, et al. Comparative wear and wear debris under three different counterface conditions of crosslinked and non-crosslinked ultra high molecular weight polyethylene. Biomed Mater Eng, 2001, 11(1): 23-35.
17. Fisher J, Mcewen H M, Tipper J L, et al. Wear, debris, and biologic activity of cross-linked polyethylene in the knee: benefits and potential concerns. Clin Orthop Relat Res, 2004(428): 114-119.
18. Kang K T, Son J, Kwon S K, et al. Preservation of femoral and tibial coronal alignment to improve biomechanical effects of medial unicompartment knee arthroplasty: computational study. Biomed Mater Eng, 2018, 29(5): 651-664.
19. Zhu G D, Guo W S, Zhang Q D, et al. Finite element analysis of mobile-bearing unicompartmental knee arthroplasty: the influence of tibial component coronal alignment. Chin Med J, 2015, 128(21): 2873-2878.
20. Bao H R C, Zhu D, Gong H, et al. The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis. Journal of Orthopaedic Science, 2013, 18(2): 256-263.s.
21. Rho J Y, Hobatho M C, Ashman R B. Relations of mechanical properties to density and CT numbers in human bone. Med Eng Phys, 1995, 17(5): 347-355.
22. 张国栋, 廖维靖, 陶圣祥, 等. 股骨有限元分析赋材料属性的方法. 中国组织工程研究与临床康复, 2009, 13(43): 8436-8441.
23. 鲍春雨, 郭宝川, 孟庆华. 人体膝关节有限元模型建立及其有效性验证. 应用力学学报, 2017, 34(3): 559-563, 615.
24. 李新宇. 一种新型人工膝关节置换假体的设计及力学评估. 太原: 太原理工大学, 2017.
25. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res, 1980(149): 283-290.
26. Peña E, Martínez M A, Calvo B, et al. A finite element simulation of the effect of graft stiffness and graft tensioning in ACL reconstruction. Clin Biomech (Bristol, Avon), 2005, 20(6): 636-644.
27. 朱广铎, 郭万首, 程立明, 等. 活动平台单髁膝关节置换胫骨后倾的有限元分析. 中国组织工程研究, 2015, 019(44): 7156-7162.
28. Cossey A J, Spriggins A J. The use of computer-assisted surgical navigation to prevent malalignment in unicompartmental knee arthroplasty. J Arthroplasty, 2005, 20(1): 29-34.
29. Pegg E C, Walter J, Mellon S J, et al. Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement. Journal of Orthopaedic Research, 2013, 31(5): 821-828.
30. Aleto T J, Berend M E, Ritter M A, et al. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty, 2008, 23(2): 159-163.
31. Marmor L. Unicompartmental knee arthroplasty. ten- to 13-year follow-up study. Clin Orthop Relat Res, 1988(226): 14-20.
32. Innocenti B, Bilgen Ö F, Labey L, et al. Load sharing and ligament strains in balanced, overstuffed and understuffed UKA. a validated finite element analysis. J Arthroplasty, 2014, 29(7): 1491-1498.
33. Emerson R J, Higgins L L. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am, 2008, 90(1): 118-122.
34. Gulati A, Chau R, Simpson D J, et al. Influence of component alignment on outcome for unicompartmental knee replacement. The Knee, 2009, 16(3): 196-199.
35. Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am, 2004, 86(3): 506-511.
36. Weber P, Schröder C, Schmidutz F, et al. Increase of tibial slope reduces backside wear in medial mobile bearing unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon), 2013, 28(8): 904-909.

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Finite element analysis of the effect of knee movable unicompartmental prosthesis insertion shape and mounting position on stress distribution in the knee joint after replacement

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