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J Knee Surg 2024; 37(13): 879-886
DOI: 10.1055/a-2344-5084
Original Article

Biomechanical Effects of Stem Extension of Tibial Components for Medial Tibial Bone Defects in Total Knee Arthroplasty: A Finite Element Study

Hyuck Min Kwon
1   Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Hyoung-Taek Hong
2   Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
,
Inuk Kim
1   Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Byung Woo Cho
1   Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Yong-Gon Koh
3   Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, Republic of Korea
,
Kwan Kyu Park‡   *
1   Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Kyoung-Tak Kang  ‡   *
2   Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Abstract

The aim of this study was to investigate the biomechanical effects of stem extension with a medial tibial bone defect in primary total knee arthroplasty (TKA) on load distribution and stress in the proximal tibia using finite element (FE) analysis.

FE simulations were performed on the tibia bone to evaluate the stress and strain on the tibia bone and bone cement. This was done to investigate the stress shielding effect, stability of the tibia plate, and the biomechanical effects in TKA models with various medial defects and different stem length models.

The results demonstrated that in the bone defect model, the longer the stem, the lower the average von Mises stress on the cortical and trabecular bones. In particular, as the bone defect increased, the average von Mises stress on cortical and trabecular bones increased. The average increase in stress according to the size of the bone defect was smaller in the long stem than in the short stem. The maximal principal strain on the trabecular bone occurred mainly at the contact point on the distal end of the stem of the tibial implant. When a short stem was applied, the maximal principal strain on the trabecular bone was approximately 8% and 20% smaller than when a long stem was applied or when no stem was applied, respectively.

The findings suggest that a short stem extension of the tibial component could help achieve excellent biomechanical results when performing TKA with a medial tibial bone defect.

Keywords

stem extension - medial tibial bone defects - total knee arthroplasty - finite element analysis

Ethical Approval

This article does not contain any studies with living sources including humans or animals.


Data Availability

The data presented in this study are available on request from the corresponding author.


Disclosure

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.


* These authors contributed equally to this work and should be considered co-corresponding authors.




Publication History

Received: 01 November 2023

Accepted: 11 June 2024

Accepted Manuscript online:
13 June 2024

Article published online:
28 June 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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