Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method

APOSTOLOPOULOS, Vasileios, Petr BOHÁČ, Petr MARCIÁN, Luboš NACHTNEBL, Michal MAHDAL, Lukáš PAZOUREK and Tomáš TOMÁŠ. Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method. JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH. LONDON: BMC, 2024, vol. 19, No 1, p. 1-12. ISSN 1749-799X. Available from: https://dx.doi.org/10.1186/s13018-024-04631-0.

Basic information

• Original name: Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method
• Name (in English): Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method
• Authors: APOSTOLOPOULOS, Vasileios (203 Czech Republic, guarantor, belonging to the institution), Petr BOHÁČ (203 Czech Republic), Petr MARCIÁN (203 Czech Republic), Luboš NACHTNEBL (203 Czech Republic, belonging to the institution), Michal MAHDAL (203 Czech Republic, belonging to the institution), Lukáš PAZOUREK (203 Czech Republic, belonging to the institution) and Tomáš TOMÁŠ (203 Czech Republic, belonging to the institution).
• Edition: JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, LONDON, BMC, 2024, 1749-799X.

Other information

• Original language: Czech
• Type of outcome: Article in a journal
• Field of Study: 30211 Orthopaedics
• Country of publisher: Germany
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 2.600 in 2022
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1186/s13018-024-04631-0
• UT WoS: 001168403100001
• Keywords in English: Total knee arthroplasty; Computational modeling; Finite element method; All-polyethylene tibial component; Metal-backed tibial component; TKR; Knee replacement; FEA
• Tags: 14110123, rivok
• Tags: International impact, Reviewed

Abstract

BackgroundTotal knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent.MethodsA standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia.ResultsThe equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 mu epsilon in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 mu epsilon, MBT only in less than 64% of the volume.ConclusionThe effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.

Abstract (in English)

BackgroundTotal knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent.MethodsA standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia.ResultsThe equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 mu epsilon in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 mu epsilon, MBT only in less than 64% of the volume.ConclusionThe effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.