Tibial cutting guide (resector) holding pins position and subsequent risks of periprosthetic fracture in unicompartmental knee arthroplasty: a finite element analysis study

Autor: Jonathan Patrick Ng, Patrick Shu-Hang Yung, Elvis Chui, Carson K.B. Kwok, Yuk-Wah Hung, Jason Chi Ho Fan, Lawrence Chun-Man Lau
Rok vydání: 2021
Předmět:
musculoskeletal diseases
Risk
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
medicine.medical_treatment
0206 medical engineering
Finite Element Analysis
Periprosthetic
02 engineering and technology
Bone Nails
Weight-Bearing
03 medical and health sciences
0302 clinical medicine
lcsh:Orthopedic surgery
Unicompartmental knee arthroplasty
medicine
Humans
Orthopedics and Sports Medicine
Biomechanics
Tibia
Arthroplasty
Replacement
Knee
Orthodontics
030222 orthopedics
business.industry
Middle Aged
musculoskeletal system
020601 biomedical engineering
Arthroplasty
Biomechanical Phenomena
lcsh:RD701-811
Periprosthetic fracture
Orthopedic surgery
Fracture (geology)
Surgery
Pinhole (optics)
Female
Stress
Mechanical
lcsh:RC925-935
Periprosthetic Fractures
business
Knee Prosthesis
Tomography
X-Ray Computed
Research Article
Zdroj: Journal of Orthopaedic Surgery and Research
Journal of Orthopaedic Surgery and Research, Vol 16, Iss 1, Pp 1-7 (2021)
ISSN: 1749-799X
Popis: Background Periprosthetic fracture of the tibia after unicompartmental knee arthroplasty has been reported to be associated with excessive pin holes created for stabilization of the cutting guide. However, fractures have also been reported in cases using two pins as in the method suggested by the manufacturer. It is currently unclear whether variations in pinhole positions make a difference in proximal tibial fracture risk. Methods Finite element models were constructed using Chinese female bone computed tomography images, with bone cuts made according to the surgical steps of implanting a fixed bearing unicompartmental arthroplasty. Four combinations of pinholes (pins placed more closely to the medial tibial cortex or centrally along the mechanical axis as allowed by the tibial cutting guide) created for tibial cutting guide placement were tested by finite element analyses. Testing loads were applied for simulating standing postures. The maximum von Mises stress on the tibial plateau was evaluated. Results Pinhole placed close to the medial edge of the proximal tibial plateau is associated with the highest stress (27.67 Mpa) and is more likely to result in medial tibial fracture. On the contrary, pinhole placed along the central axis near the tibial tuberosity has the lowest stress (1.71 Mpa) and reflects lower risk of fracture. Conclusion The present study revealed that placing tibial cutting guide holding pins centrally would lower the risks of periprosthetic fracture of the medial tibial plateau by analyzing the associated stress in various pin hole positions using finite element analysis.
Databáze: OpenAIRE
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