The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement

• Published in: Journal of biomechanics Vol. 44; no. 5; pp. 948 - 954
• Main Authors: Chong, Desmond Y.R, Hansen, Ulrich N, van der Venne, Rene, Verdonschot, Nico, Amis, Andrew A
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 15.03.2011; Elsevier; Elsevier Limited
• Subjects: Arthroplasty, Replacement, Knee - methods; Biological and medical sciences; Bone and Bones - pathology; Bone Cements; Bone remodelling/resorption; Bone Resorption; Bones; Cement; Cementation; Cemented/cementless fixation; Computerized, statistical medical data processing and models in biomedicine; Densitometry - methods; Female; Finite Element Analysis; Finite element modelling; Humans; Knee; Knee - pathology; Knee Joint - surgery; Knee Prosthesis; Medical sciences; Models and simulation; Orthopedic surgery; Osseointegration - physiology; Physical Medicine and Rehabilitation; Polyethylene - chemistry; Prosthesis Design; Stress, Mechanical; Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tibia - pathology; Tibial component fixation; Tomography, X-Ray Computed - methods; Total knee replacement; Visible Human Projects; Finite element modelling; Tibial component fixation; Cemented/cementless fixation; Total knee replacement; Bone remodelling/resorption; Total knee arthroplasty; Bone remodeling; Modeling; Osteoarticular system; Biomechanics; Finite element method; Bone resorption; Orthopedic surgery; Fixation; Treatment; Non cemented prosthesis; Bone; Technique; Biomedical engineering
• ISSN: 0021-9290; 1873-2380
• DOI: 10.1016/j.jbiomech.2010.11.026

Abstract Periprosthetic bone resorption after tibial prosthesis implantation remains a concern for long-term fixation performance. The fixation techniques may inherently aggravate the “stress-shielding” effect of the implant, leading to weakened bone foundation. In this study, two cemented tibial fixation cases (fully cemented and hybrid cementing with cement applied under the tibial tray leaving the stem uncemented) and three cementless cases relying on bony ingrowth (no, partial and fully ingrown) were modelled using the finite element method with a strain-adaptive remodelling theory incorporated to predict the change in the bone apparent density after prosthesis implantation. When the models were loaded with physiological knee joint loads, the predicted patterns of bone resorption correlated well with reported densitometry results. The modelling results showed that the firm anchorage fixation formed between the prosthesis and the bone for the fully cemented and fully ingrown cases greatly increased the amount of proximal bone resorption. Bone resorption in tibial fixations with a less secure anchorage (hybrid cementing, partial and no ingrowth) occurred at almost half the rate of the changes around the fixations with a firm anchorage. The results suggested that the hybrid cementing fixation or the cementless fixation with partial bony ingrowth (into the porous-coated prosthesis surface) is preferred for preserving proximal tibial bone stock, which should help to maintain post-operative fixation stability. Specifically, the hybrid cementing fixation induced the least amount of bone resorption.