title: Finite element analysis: a comparison of an all-polyethylene tibial implant and its metal-backed equivalent.
abstract: OBJECTIVE
  The hypothesis of this study is that all-polyethylene (APE) tibial implants offer a biomechanical profile similar to metal-backed tray (MBT). There are significant financial implications, in selected patient groups, if APE can be deemed to perform as well as MBT.
  
  
  METHODS
  Using a finite element analysis of CAD models provided by DePuy (Leeds), stress distributions were investigated for both an APE and MBT tibial implant. The performance was assessed for cancellous bone at 700 MPa (normal) and at 350 MPa (less stiff). Plots were recorded along the length of the tibia, showing the loads carried by the bone (cortical and cancellous), the implant interface, cement interface and the stem. von Mises stress distributions and percentage volumes were used to assess bone resorption and hence potential for failure (fracture).
  
  
  RESULTS
  Higher stress shielding (resorption) occurred around the keel and stem of the MBT revealing greater potential for bone loss in these areas. APE had no areas of bone resorption (being more flexible resulting in less stress shielding). The stiffer MBT carries a higher proportion of the load down the stem. MBT stress in cancellous bone is lower than APE, as load is distributed to the cortical rim. APE has a marginally favourable strain state in cancellous bone and spreads loads more at the cement interface than MBT.
  
  
  CONCLUSIONS
  Modern-day APE bearings may be superior to previously designed implants due to improvements in manufacturing. In the correct patient group, this could offer substantial cost savings.
authors.affiliation: Chelsea and Westminster NHS Trust, London, UK. s.m.thompson@ic.ac.uk.
authors.forename: S M
authors.initials: SM
authors.lastname: Thompson
authors.affiliation: Department of Mechanical Engineering, University of Surrey, Guildford, UK.
authors.forename: D
authors.initials: D
authors.lastname: Yohuno
authors.affiliation: Royal Surrey County Hospital, Egerton Rd, Surrey, GU2 7XX, UK.
authors.forename: W N
authors.initials: WN
authors.lastname: Bradley
authors.affiliation: Department of Mechanical Engineering, University of Surrey, Guildford, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Crocombe
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena; D001843:Bone Cements; D020342:Finite Element Analysis; D006801:Humans; D007720:Knee Prosthesis; D008670:Metals; D008953:Models, Anatomic; D020959:Polyethylene; D011474:Prosthesis Design; D013314:Stress, Mechanical; D013977:Tibia
chemical_list: D001843:Bone Cements; D008670:Metals; D020959:Polyethylene
keywords: All-polyethylene tibial implant; Finite element analysis; Metal-backed tibial tray; Stress