Femoral loosening of high-flexion total knee arthroplasty: The effect of posterior cruciate ligament retention and bone quality reduction

J. Zelle, S.A.W. van de Groes, M.C. De Waal Malefijt, Nicolaas Jacobus Joseph Verdonschot

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

High-flexion total knee arthroplasty (TKA) may be more sensitive to femoral loosening than conventional TKA as the knee joint force increases during deep flexion. The objective of this study was to evaluate whether the probability of femoral loosening is equal in posterior cruciate ligament (PCL) retaining and substituting high-flexion knee implants and whether loosening is related to femoral bone quality. A three-dimensional finite element (FE) model of the knee was developed and a weight-bearing deep knee bend up to 155° was simulated. PCL conservation considerably increased the compressive tibio-femoral joint force as a maximal force of 4.7–6.0 × bodyweight (BW) was found, against a maximal force of 4.0 × BW for posterior-stabilized TKA. Roughly 14% of the fixation site beneath the anterior femoral flange was predicted to debond on the long-term in case of cruciate-retaining TKA compared to 20% in case of posterior-stabilized TKA. Reducing the femoral bone quality to 50% of its original bone mineral density increased the amount of potential anterior failure for cruciate-retaining TKA to 22% and posterior-stabilized TKA to 24%. We therefore conclude that the femoral fixation site has a similar failure potential for both cruciate-retaining and posterior-stabilized high-flexion TKA
Original languageEnglish
Pages (from-to)318-324
Number of pages7
JournalMedical engineering & physics
Volume36
Issue number3
DOIs
Publication statusPublished - 2014

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Posterior Cruciate Ligament
Arthroplasty
Knee Replacement Arthroplasties
Ligaments
Thigh
Bone
Bone and Bones
Knee
Bearings (structural)
Weight-Bearing
Knee Joint
Flanges
Bone Density
Conservation
Minerals

Keywords

  • METIS-301812
  • IR-91256

Cite this

@article{09e0af69b75a4013baf83073a91333f4,
title = "Femoral loosening of high-flexion total knee arthroplasty: The effect of posterior cruciate ligament retention and bone quality reduction",
abstract = "High-flexion total knee arthroplasty (TKA) may be more sensitive to femoral loosening than conventional TKA as the knee joint force increases during deep flexion. The objective of this study was to evaluate whether the probability of femoral loosening is equal in posterior cruciate ligament (PCL) retaining and substituting high-flexion knee implants and whether loosening is related to femoral bone quality. A three-dimensional finite element (FE) model of the knee was developed and a weight-bearing deep knee bend up to 155° was simulated. PCL conservation considerably increased the compressive tibio-femoral joint force as a maximal force of 4.7–6.0 × bodyweight (BW) was found, against a maximal force of 4.0 × BW for posterior-stabilized TKA. Roughly 14{\%} of the fixation site beneath the anterior femoral flange was predicted to debond on the long-term in case of cruciate-retaining TKA compared to 20{\%} in case of posterior-stabilized TKA. Reducing the femoral bone quality to 50{\%} of its original bone mineral density increased the amount of potential anterior failure for cruciate-retaining TKA to 22{\%} and posterior-stabilized TKA to 24{\%}. We therefore conclude that the femoral fixation site has a similar failure potential for both cruciate-retaining and posterior-stabilized high-flexion TKA",
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Femoral loosening of high-flexion total knee arthroplasty: The effect of posterior cruciate ligament retention and bone quality reduction. / Zelle, J.; van de Groes, S.A.W.; De Waal Malefijt, M.C.; Verdonschot, Nicolaas Jacobus Joseph.

In: Medical engineering & physics, Vol. 36, No. 3, 2014, p. 318-324.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Femoral loosening of high-flexion total knee arthroplasty: The effect of posterior cruciate ligament retention and bone quality reduction

AU - Zelle, J.

AU - van de Groes, S.A.W.

AU - De Waal Malefijt, M.C.

AU - Verdonschot, Nicolaas Jacobus Joseph

PY - 2014

Y1 - 2014

N2 - High-flexion total knee arthroplasty (TKA) may be more sensitive to femoral loosening than conventional TKA as the knee joint force increases during deep flexion. The objective of this study was to evaluate whether the probability of femoral loosening is equal in posterior cruciate ligament (PCL) retaining and substituting high-flexion knee implants and whether loosening is related to femoral bone quality. A three-dimensional finite element (FE) model of the knee was developed and a weight-bearing deep knee bend up to 155° was simulated. PCL conservation considerably increased the compressive tibio-femoral joint force as a maximal force of 4.7–6.0 × bodyweight (BW) was found, against a maximal force of 4.0 × BW for posterior-stabilized TKA. Roughly 14% of the fixation site beneath the anterior femoral flange was predicted to debond on the long-term in case of cruciate-retaining TKA compared to 20% in case of posterior-stabilized TKA. Reducing the femoral bone quality to 50% of its original bone mineral density increased the amount of potential anterior failure for cruciate-retaining TKA to 22% and posterior-stabilized TKA to 24%. We therefore conclude that the femoral fixation site has a similar failure potential for both cruciate-retaining and posterior-stabilized high-flexion TKA

AB - High-flexion total knee arthroplasty (TKA) may be more sensitive to femoral loosening than conventional TKA as the knee joint force increases during deep flexion. The objective of this study was to evaluate whether the probability of femoral loosening is equal in posterior cruciate ligament (PCL) retaining and substituting high-flexion knee implants and whether loosening is related to femoral bone quality. A three-dimensional finite element (FE) model of the knee was developed and a weight-bearing deep knee bend up to 155° was simulated. PCL conservation considerably increased the compressive tibio-femoral joint force as a maximal force of 4.7–6.0 × bodyweight (BW) was found, against a maximal force of 4.0 × BW for posterior-stabilized TKA. Roughly 14% of the fixation site beneath the anterior femoral flange was predicted to debond on the long-term in case of cruciate-retaining TKA compared to 20% in case of posterior-stabilized TKA. Reducing the femoral bone quality to 50% of its original bone mineral density increased the amount of potential anterior failure for cruciate-retaining TKA to 22% and posterior-stabilized TKA to 24%. We therefore conclude that the femoral fixation site has a similar failure potential for both cruciate-retaining and posterior-stabilized high-flexion TKA

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KW - IR-91256

U2 - 10.1016/j.medengphy.2013.11.015

DO - 10.1016/j.medengphy.2013.11.015

M3 - Article

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SP - 318

EP - 324

JO - Medical engineering & physics

JF - Medical engineering & physics

SN - 1350-4533

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