Elsevier

The Journal of Arthroplasty

Volume 15, Issue 8, December 2000, Pages 1020-1027
The Journal of Arthroplasty

Original Articles
The importance of tibial alignment: Finite element analysis of tibial malalignment*,**,*

https://doi.org/10.1054/arth.2000.17941Get rights and content

Abstract

The influence of the tibial plateau orientation on cancellous bone stress was examined by finite element analysis for a cemented device. The objectives of the study were i) to examine the effect of the plateau-ankle angle on the cancellous bone stress, ii) to analyze the significance of the anteroposterior angles of the tibial component on these stresses, and iii) to compare the finite element predictions with clinical data. In general, positioning the tibial plateau in valgus resulted in lower cancellous bone stresses. These results support previous clinical studies, which suggest that overall alignment in valgus results in lower migration rates and lower incidence of loosening.

Section snippets

Materials and methods

A three-dimensional finite element model of a proximal right tibia was generated based on a set of serial transverse computed tomography scans of a cadaveric specimen [19]. The tibia was implanted with a flanged-type tibial plateau (Dual Bearing Knee, MMT Ltd, Birmingham, UK) as shown in Fig. 2.

. Tibial component of the Dual Bearing Knee system.

The various material properties used in the model are listed in Table 1 [19].

. Material Properties of the Implanted Tibia

MaterialModulus (GPa)Poisson RatioEmpty Cell

Results

The stress distribution on the cancellous bone in the different models (varus-valgus angles and posterior angle) is shown in Fig. 4.

. Minimum principal cancellous bone stresses at the bone-implant interface for (A) 0°; (B) 7° posterior; (C) 2.5° varus; (D) 2.5° valgus; (E) 5° varus; (F) 5° valgus.

. (G) 10° varus; (H) 10° valgus.

Regardless of the orientation of the implant, the maximum cancellous bone stresses always appeared in the medial compartment. From 10° of valgus to neutral, the load-bearing

Discussion

The aim of this study was to examine the influence of the orientation of the tibial tray on the cancellous bone stresses because they are believed to relate most closely to migration and aseptic loosening 19, 23, 24, 25. The lowest stress and lowest risk of cancellous bone failure were obtained when the tibial tray was oriented in valgus. According to the tendency observed, the larger this valgus tilt, the lower the stresses within the cancellous bone. In this study, the varus-valgus angle

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    *

    †Department of Orthopaedics, Southampton University Hospital, Southampton, United Kingdom.

    **

    Funds were received from CONICIT and Universidad Simón Bolívar, Venezuela, in support of the research material described in this article.

    *

    Reprint requests: A. Perillo-Marcone, School of Engineering Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.

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