Reduced tibial strain-shielding with extraosseous total knee arthroplasty revision system

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Title: Reduced tibial strain-shielding with extraosseous total knee arthroplasty revision system
Authors: Correa, T
Pal, B
Van Arkel, R
Vanacore, F
Amis, AA
Item Type: Journal Article
Abstract: Background Revision total knee arthroplasty (RTKA) has poorer results than primary total knee arthroplasty (TKA), and the prostheses are invasive and cause strain-shielding of the bones near the knee. This paper describes an RTKA system with extracortical fixation. It was hypothesised that this would reduce strain-shielding compared with intramedullary fixation. Methods Twelve replica tibiae were prepared for full-field optical surface strain analysis. They were either left intact, implanted with RTKA components with cemented intramedullary fixation stems, or implanted with a novel design with a tibial tray subframe supported by two extracortical fixation plates and screw fixation. They were loaded to simulate peak walking and stair climbing loads and the surface strains were measured using digital image correlation. The measurements were validated with strain gauge rosettes. Results Compared to the intact bone model, extracortical fixation reduced surface strain-shielding by half versus intramedullary fixation. For all load cases and bone regions examined, the extracortical implant shielded 8–27% of bone strain, whereas the intramedullary component shielded 37–56%. Conclusions The new fixation design, which offers less bone destruction than conventional RTKA, also reduced strain-shielding. Clinically, this design may allow greater rebuilding of bone loss, and should increase long-term fixation.
Issue Date: 1-Dec-2018
Date of Acceptance: 30-Sep-2018
ISSN: 1350-4533
Publisher: Elsevier
Start Page: 22
End Page: 28
Journal / Book Title: Medical Engineering and Physics
Volume: 62
Copyright Statement: © 2018 The Authors. Published by Elsevier Ltd on behalf of IPEM. This is an open access article under the CC BY license. (
Sponsor/Funder: Engineering & Physical Science Research Council (EPSRC)
Wellcome Trust
Funder's Grant Number: N/A
Keywords: Cortical bone fixation plate
Prosthesis design
Revision total knee arthroplasty
Stress strain shielding
02 Physical Sciences
09 Engineering
11 Medical And Health Sciences
Biomedical Engineering
Publication Status: Published
Online Publication Date: 2018-10-10
Appears in Collections:Faculty of Engineering
Mechanical Engineering

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