title: Contact stress analysis of the anterior tibial post in bi-cruciate stabilized and mobile-bearing posterior stabilized total knee arthroplasty designs.
abstract: In posterior-stabilized (PS) total knee arthroplasty (TKA), unexpected wear and fracture of the tibial post due to anterior post impingement have been reported. The purpose of this study was to determine the contact stress on the anterior aspect of the tibial post in four contemporary TKA designs. We evaluated one bi-cruciate stabilized design (Journey II) and three mobile-bearing PS designs (Vanguard RP, PFC Sigma RP, and NexGen LPS Mobile). The contact conditions at the anterior aspect of the tibial post were determined upon application of a posterior force of 100N to individual implants. Each measurement was sequentially performed five times, and the data were compared within and across designs using analysis of variance and a post-hoc test. The contact stress of the Journey II and Vanguard RP was less than the compressive yield stress for polyethylene (10MPa) at all tested flexion angles and degrees of rotation. The PFC Sigma RP did not show anterior tibial post impingement under any experimental conditions. The NexGen LPS Mobile demonstrated bilateral edge loading at the anterior tibial post and exceeded 10MPa of contact stress in some test conditions. Thus, the differences among implants in terms of the dimensions of the femoral anterior cam or intercondylar notch and the anterior aspect of the tibial post in the axial and sagittal planes led to significant differences in contact conditions. The present study helps the surgeon to be more aware that various contact conditions of the anterior aspect of the tibial post can occur in individual TKA designs.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Umito
authors.initials: U
authors.lastname: Kuwashima
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: hamachan@ortho.med.kyushu-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamai
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okazaki
authors.affiliation: Department of Mechanical Engineering, Faculty of Engineering, Kyushu Sangyo University, 2-3-1, Matsugadai, Higashi-ku, Fukuoka 813-8503, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ikebe
authors.affiliation: Department of Mechanical Engineering, Faculty of Engineering, Kyushu Sangyo University, 2-3-1, Matsugadai, Higashi-ku, Fukuoka 813-8503, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Higaki
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mizu-Uchi
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Akasaki
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Murakami
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena; D006801:Humans; D007719:Knee Joint; D007720:Knee Prosthesis; D011474:Prosthesis Design; D013977:Tibia