title: Intraoperative impaction of total knee replacements: an explicit finite-element-analysis of principal stresses in ceramic vs. cobalt-chromium femoral components.
abstract: BACKGROUND
  In connection with technological advances in the manufacturing of medical ceramics, a newly developed ceramic femoral component was introduced in total knee arthroplasty. We generated an explicit finite-element-model to calculate the stresses developed under the highly dynamic intraoperative impaction with regard to cobalt-chromium and ceramic implant material as well as application of a silicone cover in order to reduce stress.
  
  
  METHODS
  The impaction was calculated with the hammer hitting the backside of the impactor at previously measured initial velocities. Subsequently the impactor, consisting of a steel handhold and a polyoxymethylene head, hit the femoral component. Instead of modelling femoral bone, the implant was mounted on four spring elements with spring constants previously determined in an experimental impaction model. The maximum principal stresses in the implants were evaluated at 8000 increments during the first 4 ms of impact.
  
  
  RESULTS
  The ceramic implant showed principal stresses 10% to 48% higher than the cobalt chromium femoral component. The simulation of a 5mm thick silicone layer between the impactor and the femoral component showed a strong decrease of vibration resulting in a reduction of 54% to 68% of the maximum stress amounts. The calculated amounts of principal stress were beneath the ultimate bending strengths of each material.
  
  
  CONCLUSIONS
  Based on the results, intraoperative fracture of femoral components in total knee replacement may not be caused solely by impaction, but also by contributing geometrical factors such as inadequate preparation of the distal femur. In order to minimize the influence of impaction related stress peaks we recommend limiting the velocity as well as the weight of the impaction hammer when inserting femoral components. The silicone cover seems to deliver a strong decrease of implant stress and should be considered in surgery technique in the future.
authors.affiliation: Department of Orthopaedics, University of Rostock, D-18057 Rostock, Germany. daniel.kluess@med.uni-rostock.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Kluess
authors.forename: Wolfram
authors.initials: W
authors.lastname: Mittelmeier
authors.forename: Rainer
authors.initials: R
authors.lastname: Bader
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D018786:Bone Substitutes; D002516:Ceramics / Q000737:chemistry*; D002857:Chromium / Q000737:chemistry*; D003035:Cobalt / Q000737:chemistry*; D019245:Compressive Strength; D005269:Femur / Q000473:pathology / Q000503:physiopathology*; D020342:Finite Element Analysis; D006801:Humans; D007432:Intraoperative Period; D007720:Knee Prosthesis; D008422:Materials Testing; D011126:Polypropylenes / Q000737:chemistry; D012828:Silicones / Q000737:chemistry; D013314:Stress, Mechanical
chemical_list: D018786:Bone Substitutes; D011126:Polypropylenes; D012828:Silicones; D002857:Chromium; D003035:Cobalt