Journal of the Mechanical Behavior of Biomedical Materials ( IF 3.3 ) Pub Date : 2019-12-07 , DOI: 10.1016/j.jmbbm.2019.103564 Andreas Fottner 1 , Matthias Woiczinski 2 , Christian Schröder 2 , Florian Schmidutz 3 , Patrick Weber 1 , Peter E Müller 1 , Volkmar Jansson 1 , Arnd Steinbrück 1
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Purpose
Malposition of implant components in total knee arthroplasty (TKA) has consequences on tibiofemoral kinematics, contact forces and ligament tensions. To evaluate the impact of tibial baseplate malpositioning in the same knee, we conducted a computer simulation.
Methods
An established weight-bearing finite element model of a fixed bearing TKA was used for the computer simulation. To evaluate the influence of tibial baseplate malposition, calculations were consecutively performed in neutral position, at 3° and 6° of internal and external rotation and at 3 mm and 6 mm of medial and lateral translation.
Results
The highest effect of malposition was observed for ligament tensions, with a tendency of a greater influence for the 6 mm translation compared to 6° of rotation. Changes in contact forces and tibiofemoral kinematics were according to the alterations of ligament tensions. The highest ligament tension, contact force and femoral roll-back were registered for 6 mm medialization of the tibial baseplate.
Discussion
Tibial baseplate malposition effects ligament tensions, tibiofemoral contact forces and kinematics and has a risk of unfavorable clinical results due to postoperative pain, reduced range of motion, instability and a higher rate of early loosening. Therefore, surgeons should aim for a neutral position of the tibial baseplate.
中文翻译：
胫骨底板错位对TKA运动学，接触力和韧带张力的影响：数值分析。
目的
全膝关节置换术（TKA）中植入物组件的放置不当会对胫股运动学，接触力和韧带张力产生影响。为了评估同一膝关节中胫骨基板错位的影响，我们进行了计算机模拟。
方法
使用已建立的固定轴承TKA的承重有限元模型进行计算机仿真。为了评估胫骨基板错位的影响，在中性位置，内外旋转3°和6°以及内侧和外侧平移3 mm和6 mm处连续进行计算。
结果
错位对韧带张力的影响最大，与旋转6°相比，对6 mm平移的影响更大。接触力和胫股运动学的变化根据韧带张力的变化而变化。胫骨底板的6 mm内翻记录了最高的韧带张力，接触力和股骨后倾。
讨论
胫骨基板位置不正确会影响韧带张力，胫股接触力和运动学，并且由于术后疼痛，活动范围减少，不稳定和早期松动率较高，可能会产生不利的临床结果。因此，外科医生应将胫骨基板定位在中间位置。
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