Stress Shielding in the Proximal Tibia after Total Knee Arthroplasty: A Finite Element Analysis of 2- and 4-mmthick Tibia Prosthesis Models
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Abstract
Objective: Proximal tibial bone resorption and osteolysis after total knee arthroplasty occur despite improved design and manufacturing processes. We utilized finite element analysis to study these phenomena.
Methods: We use SOLIDWORKS 2018 software to study stress and displacement of normal tibias and tibias implanted with a 4-mm-thick CoCr tibial tray (4mm-tray) or 2-mm-thick titanium alloy (2mm-tray). Under vertical loads of 1000 or 2000 N, the stress and displacement of both tibia tray models were analyzed. Stress on the supported proximal tibia 1 and 2 cm beneath the surface was analyzed and compared to stress in a normal tibia.
Results: Stress concentrated around the central region compared to the peripheral region in all models, which caused more deformation of the material in the central region. However, the 4mm-tray exhibited a more rigid construct compared to the 2mm-tray. Under any load, the 2mm-tray exhibited more tray deformation, with a central–peripheral deformation difference of approximately five times more than the deformation difference for the 4mm-tray. Moreover, stress on the peripheral region of the supported proximal tibia was only 18–22% of that of a normal bone for the 4mm-tray compared to 54–66% for the 2mm-tray.
Conclusion: Both tibial tray implant models exhibited some degree of stress shielding on the peripheral region of the supported proximal tibia. However, the greater modulus and thicker baseplate construct of the 4-mm CoCr tray exhibited a profound stress shielding effect. This stress shielding may correlate with a higher incidence of proximal tibia bone loss.
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