title: A different fixation of the femoral component in total knee arthroplasty may lead to preservation of femoral bone stock.
abstract: Good femoral bone stock is important for the stability of the femoral component in revision knee arthroplasty. However, the primary total knee replacement (TKR) may cause significant loss of bone stock in the distal anterior femur. Earlier stress-induced bone remodelling simulations have suggested that a completely debonded component may save bone stock in the distal anterior region. However, these simulations did not consider the fixation of a debonded implant and possible secondary effects of micromotions and osteolysis at the interface. The current study tries to combine the preservation of bone stock with adequate component fixation. Different bone remodelling simulations were performed around femoral knee components with different sizes of bonding area and different friction characteristics of the debonded area. The fixation of the femoral component with different bonding characteristics is quantified with calculated implant-bone interface stresses. The results show that a bonded femoral component with a debonded inner side of the anterior flange may significantly reduce bone resorption in the endangered distal anterior femur, without jeopardizing the fixation of the femoral implant. This effect may be obtained in vivo by using a femoral component with a highly polished inner side of the anterior flange.
authors.affiliation: Orthopaedic Research Laboratory, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Barink
authors.forename: N
authors.initials: N
authors.lastname: Verdonschot
authors.forename: M
authors.initials: M
authors.lastname: de Waal Malefijt
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016723:Bone Remodeling; D001862:Bone Resorption / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D002484:Cementation / Q000379:methods*; D003198:Computer Simulation; D004548:Elasticity; D019544:Equipment Failure Analysis; D005269:Femur / Q000503:physiopathology* / Q000601:surgery; D020342:Finite Element Analysis; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D008954:Models, Biological; D011475:Prosthesis Failure; D013314:Stress, Mechanical; D016474:Weight-Bearing