title: The effect of bearing congruency, thickness and alignment on the stresses in unicompartmental knee replacements.
abstract: BACKGROUND
  Unicompartmental knee replacement offers an effective treatment for patients with single compartment knee disease and is becoming an increasingly popular alternative to total knee replacement. An important cause of failure in a unicompartmental knee replacement implant is polyethylene wear. Significant contributory factors to the amount of polyethylene wear are contact stress, bearing alignment, congruency and thickness.
  
  
  METHODS
  Four different unicompartmental knee replacement implant designs (Fully-Congruent; Partially-Congruent; Non-Congruent-metal-backed; Non-Congruent-all-polyethylene) were inserted into a validated finite element model of a proximal tibia. The effect that bearing congruency, alignment and thickness had on the polyethylene stresses during a simulated step-up activity for each design was investigated. Additionally, contact pressures were compared to those calculated from Hertz elastic theory.
  
  
  RESULTS
  Only the Fully-Congruent bearing experienced peak von Mises and contact stresses below the lower fatigue limit for polyethylene during the step-up activity. The highest polyethylene contact stresses were observed for the Partially-Congruent and Non-Congruent-metal-backed designs, which experienced approximately three times the polyethylene lower fatigue limit. Increasing the bearing thickness from 3.5mm to 8.5mm of the Non-Congruent design decreased the contact stresses in the bearing; however they did not fall below the lower fatigue limit for polyethylene. Good agreement between finite element and Hertz contact pressures was found.
  
  
  CONCLUSIONS
  Fully congruent unicompartmental knee replacement bearings can be markedly thinner without approaching the material failure limit, have a greater potential to preserve bone stock and are less likely to fail mechanically.
authors.affiliation: Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Simpson
authors.forename: H
authors.initials: H
authors.lastname: Gray
authors.forename: D
authors.initials: D
authors.lastname: D'Lima
authors.forename: D W
authors.initials: DW
authors.lastname: Murray
authors.forename: H S
authors.initials: HS
authors.lastname: Gill
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods*; D003198:Computer Simulation; D055119:Elastic Modulus; D006622:Hip Prosthesis; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008954:Models, Biological; D013314:Stress, Mechanical; D013977:Tibia / Q000503:physiopathology* / Q000601:surgery