Effect of design and surgical parameters variations in mobile-bearing versus fixed-bearing unicompartmental knee arthroplasty: A finite element analysis

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-26 DOI:10.1002/jeo2.70053

Thomas Luyckx, Edoardo Bori, Rachele Saldari, Sara Fiore, Virginia Altamore, Bernardo Innocenti

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Abstract

Purpose

Unicompartmental knee arthroplasty (UKAs) are available in the market as fixed- and mobile-bearing (FB and MB) and can be characterised by a different set of design parameters in terms of geometries, materials and surgical approaches, with overall good clinical outcomes. However, clear biomechanical evidence concerning the consequences of variations of these features on knee biomechanics is still lacking; therefore, the present study aims to perform a sensitivity analysis to see which outcomes are affected by these variations.

Methods

For both MB-UKA and FB-UKA, five design and surgical parameters were defined (bearing insert thickness, tibial component material, implant components friction coefficient, antero-posterior slope angle and level of tibial bone resection). Two control models were defined based on standard configurations for both implants. Finite element analysis was chosen to perform this study, and different parameter combinations (216 models in total) were implemented and tested at both 0° and 90° of flexion, using a previously validated finite element knee model. The results were then evaluated in terms of bone and polyethylene Von Mises stress and tibio-femoral contact area.

Results

Bearing thickness, tibial bone cut and slope angle were found to be the most sensitive parameters for both types of UKAs. Specifically, changes in these parameters in the FB-UKA appeared to induce more significant variations in the polyethylene insert (both in terms of polyethylene stress and contact area), while in the MB-UKA, these changes influenced bone stress distribution more.

Conclusions

Surgical parameters returned to have a more significant influence than material and friction variations; furthermore, the outcomes most affected by parameter variations were the insert-related ones for FB-UKA while for the MB-UKA were the ones regarding tibial bone stresses.

Level of Evidence

Not Applicable.

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移动式与固定式单室膝关节置换术中设计和手术参数变化的影响：有限元分析

目的：单髁膝关节置换术（UKA）在市场上有固定和活动承载（FB 和 MB）两种类型，在几何形状、材料和手术方法方面有不同的设计参数，总体临床效果良好。然而，关于这些特征的变化对膝关节生物力学的影响，目前仍缺乏明确的生物力学证据；因此，本研究旨在进行敏感性分析，以了解这些变化会对哪些结果产生影响：对于 MB-UKA 和 FB-UKA，定义了五个设计和手术参数（轴承衬垫厚度、胫骨组件材料、植入组件摩擦系数、前后倾斜角度和胫骨切除水平）。根据两种植入体的标准配置定义了两个对照模型。本研究选择了有限元分析法，并使用先前验证过的有限元膝关节模型，在屈曲 0° 和 90° 时对不同的参数组合（共 216 个模型）进行了实施和测试。然后根据骨和聚乙烯 Von Mises 应力以及胫骨-股骨接触面积对结果进行评估：结果：研究发现，轴承厚度、胫骨切口和斜坡角度是两种 UKAs 最敏感的参数。具体来说，在 FB-UKA 中，这些参数的变化似乎会引起聚乙烯插入物更显著的变化（在聚乙烯应力和接触面积方面），而在 MB-UKA 中，这些变化对骨应力分布的影响更大：结论：与材料和摩擦力的变化相比，手术参数的影响更为显著；此外，对于 FB-UKA 而言，受参数变化影响最大的是与插入物相关的结果，而对于 MB-UKA 而言，受参数变化影响最大的是与胫骨骨应力相关的结果：证据等级：不适用。

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