How does asymmetric tibial insert affect tibiofemoral kinematics and contact stresses in total knee Arthroplasty? |
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| Institution: | 1. Servicio de Traumatología y Ortopedia, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, Mexico;2. Unidad de VIH, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, Mexico;3. Universidad de Guadalajara, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico;4. Servicio de Radiología e Imagen, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, Mexico;1. Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan;2. Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan;1. Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin, Turkey;2. Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey;1. Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China;2. Suzhou Medical College of Soochow University, Suzhou, PR China;3. Department of Orthopedics, Wujiang Fourth People’s Hospital, Wujiang, Suzhou, PR China;1. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil;2. Hospital Sírio Libanês, São Paulo, Brazil;1. Department of Orthopaedic Surgery, University of Maryland Medical Center, 110 South Paca Street 6th Floor Suite 300, Baltimore, MD 21201, United States;2. Orthopaedic Institute at University of Maryland St. Joseph’s Medical Center, 7601 Osler Dr., Towson, MD 21204, United States |
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| Abstract: | BackgroundAsymmetric tibial insert design is expected to restore normal knee kinematics better than symmetric design. A tri-condylar implant has asymmetric and symmetric tibial inserts with a ball-and-socket joint to replace the post-cam mechanism. The purpose of this study was to compare the knee kinematics of the two designs and to measure tibiofemoral contact stresses, including that of the ball-and-socket joint.MethodsUsing a computer simulation, the anteroposterior position and axial rotation of the femoral component were simulated during a weight-bearing deep knee bend for six validated models. Contact forces were simultaneously simulated in the medial, lateral, and ball-and-socket compartments. The relative position and the magnitude and direction of each contact force were applied to aforce/displacement control knee simulator. The contact stresses were measured individually using a pressure sensor.ResultsThe asymmetric tibial insert demonstrated a more posterior position of the femoral component in the lateral compartment during the entire range of motion and greater external rotation of the femoral component, compared to the symmetrical tibial insert. The mean peak contact stress of the medial and lateral compartments was < 9 Mpa, with no significant differences between the two designs except at 0°. The contact stress of the ball-and-socket joint was < 5 MPa.ConclusionsAsymmetry of the tibial insert shows significant kinematic difference and has little influence on the peak contact stress, which is considerably lower than the yield strength of polyethylene. The asymmetric tibial insert can lead to clinical benefits owing to its kinematic and kinetic properties. |
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| Keywords: | Total knee arthroplasty Computer simulation Knee simulator Kinematics Contact mechanics |
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