Stemmed implants improve stability in augmented constrained condylar knees.

Clinical Orthopaedics and Related Research
Jeremy J RawlinsonRussell Windsor

Abstract

We previously combined experimental and computational measures to ascertain whether tibial stem augmentation reduces bone strains beneath constrained condylar implants. Using these same integrated approaches, we examined the benefit of a stem when a wedge is used. Implants were removed from the eight paired cadaver specimens from our previous experiment, and oblique defects created that were restored with 15 degrees metallic wedges cemented in place. We applied a varus moment and an axial load and monitored relative motion between implant and bone. Specimen-specific 3-D finite element models were constructed from CT scans and radiographs to examine bone stress in the proximal tibia. Implants with a wedge but no stem had greater motion than the previous control with no stem or wedge. Use of a modular stem with a wedge maintained the same level of motion as the primary case, suggesting that a stem is preferable when a wedge is utilized. The computational models confirmed this conclusion with a 30% reduction in bone stress compared to 17% in the primary case without a wedge. The wedge carried more axial load compared to the primary implant due to its support on stiff metaphyseal bone.

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Citations

Mar 29, 2014·Advances in Orthopedics·Nicole DurigMelinda K Harman
Jan 2, 2015·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Ajit J DeshmukhAlan J Dayan
Nov 11, 2010·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Bum-Sik LeeSeong-Il Bin
Dec 21, 2012·International Journal for Numerical Methods in Biomedical Engineering·Mark TaylorFrancis Galloway
Sep 7, 2016·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Marrigje F MeijerSjoerd K Bulstra
Sep 17, 2015·Current Reviews in Musculoskeletal Medicine·Andrea BaldiniVincenzo Franceschini
May 23, 2020·The Journal of Knee Surgery·Ahmed M Samy, Wael Azzam

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