Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Longfei ¹ , LIN Tianye ^2,3 , HE Mincong ^2,3 , HE Xiaoming ^2,3 , ZHAN Zhiwei ¹ , LU Shun ¹ , ZENG Zijun ¹ , LIN Kun ¹ , TIAN Jiaqing ¹ , HOU Wenyuan ¹ , WEI Tengfei ¹ ,  WEI Qiushi ^2,3,4

1. Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China;
3. Department of Joint Center, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P. R. China;
4. State Key Laboratory of Traditional Chinese Medicine Syndrome/Orthopaedics, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P. R. China;

Corresponding author：

WEI Qiushi, Email: weiqshi@126.com

Keywords：

Knee osteoarthritis; lower limb force line; low-density area; knee varum; finite element analysis

DOI：

10.7507/1002-1892.202312026

Video：

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Objective To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau. Methods A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results. Results The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences (P<0.05). Conclusion The existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.

Citation： HAN Longfei, LIN Tianye, HE Mincong, HE Xiaoming, ZHAN Zhiwei, LU Shun, ZENG Zijun, LIN Kun, TIAN Jiaqing, HOU Wenyuan, WEI Tengfei, WEI Qiushi. Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 734-741. doi: 10.7507/1002-1892.202312026 Copy

1.	Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet, 2005, 365(9463): 965-973.
2.	Zhang Z, Huang C, Jiang Q, et al. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). Ann Transl Med, 2020, 8(19): 1213. doi: 10.21037/atm-20-4665.
3.	林华, 包丽华. 骨质疏松性骨折的骨损害. 中华医学杂志, 2022, 102(13): 903-907.
4.	曾国庆, 董铿, 黄建军. 膝骨关节炎与骨质疏松症的相关性分析. 中国卫生标准管理, 2023, 14(18): 94-97.
5.	Hulet C, Sabatier JP, Souquet D, et al. Distribution of bone mineral density at the proximal tibia in knee osteoarthritis. Calcif Tissue Int, 2002, 71(4): 315-322.
6.	Li Y, Liem Y, Dall’Ara E, et al. Subchondral bone microarchitecture and mineral density in human osteoarthritis and osteoporosis: A regional and compartmental analysis. J Orthop Res, 2021, 39(12): 2568-2580.
7.	Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women. Clin Orthop Surg, 2014, 6(4): 420-425.
8.	Geusens PP, van den Bergh JP. Osteoporosis and osteoarthritis: shared mechanisms and epidemiology. Curr Opin Rheumatol, 2016, 28(2): 97-103.
9.	Stamenkovic BN, Rancic NK, Bojanovic MR, et al. Is osteoarthritis always associated with low bone mineral density in elderly patients? Medicina (Kaunas), 2022, 58(9): 1207. doi: 10.3390/medicina58091207.
10.	詹芝玮, 韦雨柔, 林天烨, 等. 膝骨关节炎内翻畸形与胫骨平台下低密度影面积的关联. 中华关节外科杂志 (电子版), 2023, 17(2): 209-215.
11.	Zhang ZH, Qi YS, Wei BG, et al. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol, 2023, 11: 1127289. doi: 10.3389/fbioe.2023.1127289.
12.	黄道强. 腓骨高位截骨治疗膝关节内侧间室骨性关节炎的有限元分析. 广州: 南方医科大学, 2020.
13.	汪小健, 吕帅洁, 李少广, 等. 全膝关节置换术中下肢机械轴的研究进展. 中国骨伤, 2021, 34(2): 191-194.
14.	Yan M, Liang T, Zhao H, et al. Model properties and clinical application in the finite element analysis of knee joint: A review. Orthop Surg, 2024, 16(2): 289-302.
15.	Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976), 2003, 28(10): 991-996.
16.	陈彦飞, 鲁超, 赵勇, 等. 基于CT影像动态膝关节有限元模型的构建及仿真力学分析. 中国骨伤. 2020, 33(5): 479-484.
17.	李钟鑫. 膝关节单间室假体置换的生物力学研究. 天津: 天津理工大学, 2021.
18.	刘蒙飞, 马鹏程, 尹灿, 等. 不同骨密度对膝关节单髁置换后关节内各结构影响的三维有限元分析. 中国组织工程研究, 2024, 28(24): 3801-3806.
19.	Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
20.	杨鹏, 魏秋实, 陈达, 等. 基于头臼接触理论构建具有精确软骨受力面的股骨近端三维模型. 广东医学, 2017, 38(20): 3127-3131.
21.	张伟光. 固定平台单髁膝关节置换在不同胫骨后倾截骨角度下的有限元分析. 大连: 大连医科大学, 2023.
22.	Taylor WR, Heller MO, Bergmann G, et al. Tibio-femoral loading during human gait and stair climbing. J Orthop Res, 2004, 22(3): 625-632.
23.	马鹏程, 张思平, 孙荣鑫, 等. 单髁置换股骨假体不同放置位置的生物力学效应. 中国组织工程研究, 2022, 26(12): 1843-1848.
24.	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, 19(44): 7156-7162.
25.	Abramoff B, Caldera FE. Osteoarthritis: Pathology, diagnosis, and treatment options. Med Clin North Am, 2020, 104(2): 293-311.
26.	Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res, 2018, 11: 2189-2196.
27.	陈德胜, 张晨, 王硕, 等. 膝关节骨性关节炎股骨髁负重区与非负重区组织形态学观察的研究. 中国当代医药, 2023, 30(20): 5-8,封3.
28.	Mills K, Hunt MA, Leigh R, et al. A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking. Clin Biomech (Bristol, Avon), 2013, 28(7): 713-724.
29.	李西海, 许丽梅, 李慧, 等. 不均匀沉降理论与膝骨关节炎筋骨失衡的关系. 中华中医药杂志, 2019, 34(4): 1481-1483.
30.	Barnsley J, Buckland G, Chan PE, et al. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res, 2021, 33(4): 759-773.
31.	Hartley A, Gregson CL, Paternoster L, et al. Osteoarthritis: Insights offered by the study of bone mass genetics. Curr Osteoporos Rep, 2021, 19(2): 115-122.
32.	Linde KN, Puhakka KB, Langdahl BL, et al. Bone mineral density is lower in patients with severe knee osteoarthritis and attrition. Calcif Tissue Int, 2017, 101(6): 593-601.
33.	胡楠, 王沛, 张竞, 等. 骨质疏松型膝骨关节炎患者骨代谢及生活质量评估. 中国骨质疏松杂志, 2023, 29(6): 832-839.
34.	王绍龙, 李腾飞, 郭宗磊, 等. 绝经后膝骨关节炎患者骨密度与内翻畸形的相关性研究. 医学研究杂志, 2023, 52(1): 84-88, 92.
35.	Chaudhary M, Walker PS. Analysis of an early intervention distal femoral resurfacing implant for medial osteoarthritis. J Biomech, 2016, 49(15): 3676-3681.
36.	Boyd JL, Zavatsky AB, Gill HS. Does increasing applied load lead to contact changes indicative of knee osteoarthritis? A subject-specific FEA study. Int J Numer Method Biomed Eng, 2016, 32(4): e02740. doi: 10.1002/cnm.2740.
37.	Saeidi M, Ramezani M, Kelly P, et al. Preliminary study on a novel minimally invasive extra-articular implant for unicompartmental knee osteoarthritis. Med Eng Phys, 2019, 67: 96-101.
38.	Yang JC, Lin KY, Lin HH, et al. Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis. PLoS One, 2021, 16(2): e0247412. doi: 10.1371/journal.pone.0247412.
39.	Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
40.	张吉超, 董跃福, 牟志芳, 等. 骨关节炎患者在不同步态角度下膝关节内部生物力学变化的有限元分析. 中国组织工程研究. 2022, 26(9): 1357-1361.

1. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet, 2005, 365(9463): 965-973.
2. Zhang Z, Huang C, Jiang Q, et al. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). Ann Transl Med, 2020, 8(19): 1213. doi: 10.21037/atm-20-4665.
3. 林华, 包丽华. 骨质疏松性骨折的骨损害. 中华医学杂志, 2022, 102(13): 903-907.
4. 曾国庆, 董铿, 黄建军. 膝骨关节炎与骨质疏松症的相关性分析. 中国卫生标准管理, 2023, 14(18): 94-97.
5. Hulet C, Sabatier JP, Souquet D, et al. Distribution of bone mineral density at the proximal tibia in knee osteoarthritis. Calcif Tissue Int, 2002, 71(4): 315-322.
6. Li Y, Liem Y, Dall’Ara E, et al. Subchondral bone microarchitecture and mineral density in human osteoarthritis and osteoporosis: A regional and compartmental analysis. J Orthop Res, 2021, 39(12): 2568-2580.
7. Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women. Clin Orthop Surg, 2014, 6(4): 420-425.
8. Geusens PP, van den Bergh JP. Osteoporosis and osteoarthritis: shared mechanisms and epidemiology. Curr Opin Rheumatol, 2016, 28(2): 97-103.
9. Stamenkovic BN, Rancic NK, Bojanovic MR, et al. Is osteoarthritis always associated with low bone mineral density in elderly patients? Medicina (Kaunas), 2022, 58(9): 1207. doi: 10.3390/medicina58091207.
10. 詹芝玮, 韦雨柔, 林天烨, 等. 膝骨关节炎内翻畸形与胫骨平台下低密度影面积的关联. 中华关节外科杂志 (电子版), 2023, 17(2): 209-215.
11. Zhang ZH, Qi YS, Wei BG, et al. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol, 2023, 11: 1127289. doi: 10.3389/fbioe.2023.1127289.
12. 黄道强. 腓骨高位截骨治疗膝关节内侧间室骨性关节炎的有限元分析. 广州: 南方医科大学, 2020.
13. 汪小健, 吕帅洁, 李少广, 等. 全膝关节置换术中下肢机械轴的研究进展. 中国骨伤, 2021, 34(2): 191-194.
14. Yan M, Liang T, Zhao H, et al. Model properties and clinical application in the finite element analysis of knee joint: A review. Orthop Surg, 2024, 16(2): 289-302.
15. Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976), 2003, 28(10): 991-996.
16. 陈彦飞, 鲁超, 赵勇, 等. 基于CT影像动态膝关节有限元模型的构建及仿真力学分析. 中国骨伤. 2020, 33(5): 479-484.
17. 李钟鑫. 膝关节单间室假体置换的生物力学研究. 天津: 天津理工大学, 2021.
18. 刘蒙飞, 马鹏程, 尹灿, 等. 不同骨密度对膝关节单髁置换后关节内各结构影响的三维有限元分析. 中国组织工程研究, 2024, 28(24): 3801-3806.
19. Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
20. 杨鹏, 魏秋实, 陈达, 等. 基于头臼接触理论构建具有精确软骨受力面的股骨近端三维模型. 广东医学, 2017, 38(20): 3127-3131.
21. 张伟光. 固定平台单髁膝关节置换在不同胫骨后倾截骨角度下的有限元分析. 大连: 大连医科大学, 2023.
22. Taylor WR, Heller MO, Bergmann G, et al. Tibio-femoral loading during human gait and stair climbing. J Orthop Res, 2004, 22(3): 625-632.
23. 马鹏程, 张思平, 孙荣鑫, 等. 单髁置换股骨假体不同放置位置的生物力学效应. 中国组织工程研究, 2022, 26(12): 1843-1848.
24. 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, 19(44): 7156-7162.
25. Abramoff B, Caldera FE. Osteoarthritis: Pathology, diagnosis, and treatment options. Med Clin North Am, 2020, 104(2): 293-311.
26. Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res, 2018, 11: 2189-2196.
27. 陈德胜, 张晨, 王硕, 等. 膝关节骨性关节炎股骨髁负重区与非负重区组织形态学观察的研究. 中国当代医药, 2023, 30(20): 5-8,封3.
28. Mills K, Hunt MA, Leigh R, et al. A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking. Clin Biomech (Bristol, Avon), 2013, 28(7): 713-724.
29. 李西海, 许丽梅, 李慧, 等. 不均匀沉降理论与膝骨关节炎筋骨失衡的关系. 中华中医药杂志, 2019, 34(4): 1481-1483.
30. Barnsley J, Buckland G, Chan PE, et al. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res, 2021, 33(4): 759-773.
31. Hartley A, Gregson CL, Paternoster L, et al. Osteoarthritis: Insights offered by the study of bone mass genetics. Curr Osteoporos Rep, 2021, 19(2): 115-122.
32. Linde KN, Puhakka KB, Langdahl BL, et al. Bone mineral density is lower in patients with severe knee osteoarthritis and attrition. Calcif Tissue Int, 2017, 101(6): 593-601.
33. 胡楠, 王沛, 张竞, 等. 骨质疏松型膝骨关节炎患者骨代谢及生活质量评估. 中国骨质疏松杂志, 2023, 29(6): 832-839.
34. 王绍龙, 李腾飞, 郭宗磊, 等. 绝经后膝骨关节炎患者骨密度与内翻畸形的相关性研究. 医学研究杂志, 2023, 52(1): 84-88, 92.
35. Chaudhary M, Walker PS. Analysis of an early intervention distal femoral resurfacing implant for medial osteoarthritis. J Biomech, 2016, 49(15): 3676-3681.
36. Boyd JL, Zavatsky AB, Gill HS. Does increasing applied load lead to contact changes indicative of knee osteoarthritis? A subject-specific FEA study. Int J Numer Method Biomed Eng, 2016, 32(4): e02740. doi: 10.1002/cnm.2740.
37. Saeidi M, Ramezani M, Kelly P, et al. Preliminary study on a novel minimally invasive extra-articular implant for unicompartmental knee osteoarthritis. Med Eng Phys, 2019, 67: 96-101.
38. Yang JC, Lin KY, Lin HH, et al. Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis. PLoS One, 2021, 16(2): e0247412. doi: 10.1371/journal.pone.0247412.
39. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
40. 张吉超, 董跃福, 牟志芳, 等. 骨关节炎患者在不同步态角度下膝关节内部生物力学变化的有限元分析. 中国组织工程研究. 2022, 26(9): 1357-1361.

Chinese Journal of Reparative and Reconstructive Surgery

Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment

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