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The biomechanics of metaphyseal cone augmentation in revision knee replacement.

The biomechanics of metaphyseal cone augmentation in revision knee replacement.

Authors :
Hu J
Gundry M
Zheng K
Zhong J
Hourigan P
Meakin JR
Winlove CP
Toms AD
Knapp KM
Chen J
Source :
Journal of the mechanical behavior of biomedical materials [J Mech Behav Biomed Mater] 2022 Jul; Vol. 131, pp. 105233. Date of Electronic Publication: 2022 Apr 17.
Publication Year :
2022

Abstract

The demand for revision knee replacement (RKR) has increased dramatically with rising patient life expectancy and younger recipients for primary TKR. However, significant challenges to RKR arise from osseous defects, reduced bone quality, potential bone volume loss from implant removal and the need to achieve implant stability. This study utilizes the outcomes of an ongoing RKR clinical trial using porous metaphyseal cones 3D-printed of titanium, to investigate 1) bone mineral density (BMD) changes in three fixation zones (epiphysis, metaphysis, and diaphysis) over a year and 2) the biomechanical effects of the cones at 6 months post-surgery. It combines dual-energy x-ray absorptiometry (DXA), computed tomography (CT) with patient-specific based finite element (FE) modelling. Bone loss (-0.086 ± 0.05 g/cm <superscript>2</superscript> ) was found in most patients over the first year. The biomechanical assessment considered four different loading scenarios from standing, walking on a flat surface, and walking downstairs, to a simulated impact of the knee. The patient-specific FE models showed that the cones marginally improved the strain distribution in the bone and shared the induced load but played a limited role in reducing the risks of bone fracture or cement debonding. This technique of obtaining real live data from a randomized clinical trial and inserting it into an in-silico FE model is unique and innovative in RKR research. The tibia RKR biomechanics examined open up further possibilities, allowing the in-silico testing of prototypes and implant combinations without putting patients at risk as per the recommended IDEAL framework standards. This process with further improvements could allow rapid innovation, optimization of implant design, and improve surgical planning.<br /> (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Details

Language :
English
ISSN :
1878-0180
Volume :
131
Database :
MEDLINE
Journal :
Journal of the mechanical behavior of biomedical materials
Publication Type :
Academic Journal
Accession number :
35504197
Full Text :
https://doi.org/10.1016/j.jmbbm.2022.105233