Effect of prosthetic joint line installation height errors on insert wear in unicompartmental knee arthroplasty_Journal of Biomedical Engineering

Authors：

XIONG Shoulin ¹ , QU Yafei ¹ , REN Jiaxuan ¹ , ZHANG Jing ¹ , LI Hui ² ,  CHEN Zhenxian ¹

1. School of Construction Machinery, Chang’an University, Xi’an 710064, P. R. China;
2. Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, P. R. China;

Corresponding author：

CHEN Zhenxian, Email: zhenxian_chen@yeah.net

Keywords：

Unicompartmental knee arthroplasty; Joint line; Contact mechanics; Wear prediction

DOI：

10.7507/1001-5515.202307051

Video：

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The clinical performance and failure issues are significantly influenced by prosthetic malposition in unicompartmental knee arthroplasty (UKA). Uncertainty exists about the impact of the prosthetic joint line height in UKA on tibial insert wear. In this study, we combined the UKA musculoskeletal multibody dynamics model, finite element model and wear model to investigate the effects of seven joint line height cases of fixed UKA implant on postoperative insert contact mechanics, cumulative sliding distance, linear wear depth and volumetric wear. As the elevation of the joint line height in UKA, the medial contact force and the joint anterior-posterior translation during swing phase were increased, and further the maximum von Mises stress, contact stress, linear wear depth, cumulative sliding distance, and the volumetric wear also were increased. Furthermore, the wear area of the insert gradually shifted from the middle region to the rear. Compared to 0 mm joint line height, the maximum linear wear depth and volumetric wear were decreased by 7.9% and 6.8% at –2 mm joint line height, and by 23.7% and 20.6% at –6 mm joint line height, the maximum linear wear depth and volumetric wear increased by 10.7% and 5.9% at +2 mm joint line height, and by 24.1% and 35.7% at +6 mm joint line height, respectively. UKA prosthetic joint line installation errors can significantly affect the wear life of the polyethylene inserted articular surfaces. Therefore, it is conservatively recommended that clinicians limit intraoperative UKA joint line height errors to –2−+2 mm.

Citation： XIONG Shoulin, QU Yafei, REN Jiaxuan, ZHANG Jing, LI Hui, CHEN Zhenxian. Effect of prosthetic joint line installation height errors on insert wear in unicompartmental knee arthroplasty. Journal of Biomedical Engineering, 2023, 40(6): 1192-1199. doi: 10.7507/1001-5515.202307051 Copy

1.	Berger R A, Meneghini R M, Jacobs J J, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am, 2005, 87(5): 999-1006.
2.	Lombardi A V, Berend K R, Walter C A, et al. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?. Clin Orthop Relat Res, 2009, 467(6): 1450-1457.
3.	Beard D J Jr, Price A J, Cook J, et al. Total or partial knee replacement for medial osteoarthritis? early results from the TOPKAT trial. Arthroscopy, 2017, 33(10): 91-92.
4.	Calkins T E, Hannon C P, Fillingham Y A, et al. Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4-19 years of follow-up: a concise follow-up of a previous report. J Arthroplasty, 2021, 36(3): 917-921.
5.	Patil S, Colwell C W Jr, Ezzet K A, et al. Can normal knee kinematics be restored with unicompartmental knee replacement?. J Bone Joint Surg Am, 2005, 87(2): 332-338.
6.	Koh Y G, Lee J A, Lee H Y, et al. Computational wear prediction of insert conformity and material on mobile-bearing unicompartmental knee arthroplasty. Bone joint Res, 2019, 8(11): 563-569.
7.	Lee S Y, Bae J H, Kim J G, et al. The influence of surgical factors on dislocation of the meniscal bearing after Oxford medial unicompartmental knee replacement: a case-control study. Bone Joint J, 2014, 96-B(7): 914-922.
8.	Rajgopal A, Panda I, Tyagi V C. Early failure with massive metallosis and posteromedial wear following atraumatic anterior cruciate ligament rupture after medial unicompartmental knee arthroplasty. Arthroplast Today, 2018, 4(1): 15-19.
9.	Lo Presti M, Raspugli G F, Reale D, et al. Early failure in medial unicondylar arthroplasty: radiographic analysis on the importance of joint line restoration. J Knee Surg, 2019, 32(9): 860-865.
10.	Flören M, Davis J, Peterson M G, et al. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty, 2007, 22(6 Suppl 2): 51-57.
11.	Ensini A, Catani F, Biasca N, et al. Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 495-502.
12.	Kwon O R, Kang K T, Son J, et al. Importance of joint line preservation in unicompartmental knee arthroplasty: finite element analysis. J Orthop Res, 2017, 35(2): 347-352.
13.	Kang K-T, Kwon O-R, Son J, et al. Effect of joint line preservation on mobile-type bearing unicompartmental knee arthroplasty: finite element analysis. Australas Phys Eng Sci Med, 2018, 41(1): 201-208.
14.	Pellikaan P, Van Der Krogt M M, Carbone V, et al. Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity. J Biomech, 2014, 47(5): 1144-1150.
15.	Andersen M S, Rasmussen J. Total knee replacement musculoskeletal model using a novel simulation method for non-conforming joints// Proceedings of the International Society of Biomechanics Conference(ISBS). Belgium: International Society of Biomechanics, 2011.
16.	Blankevoort L, Huiskes R, De Lange A. Recruitment of knee joint ligaments. J Biomech Eng, 1991, 113(1): 94-103.
17.	Thelen D G, Won Choi K, Schmitz A M. Co-simulation of neuromuscular dynamics and knee mechanics during human walking. J Biomech Eng, 2014, 136(2): 021033.
18.	Blankevoort L, Kuiper J H, Huiskes R, et al. Articular contact in a three-dimensional model of the knee. J Biomech, 1991, 24(11): 1019-1031.
19.	Chen Z, Zhang Z, Wang L, et al. Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty. Med Eng Phys, 2016, 38(8): 708-716.
20.	Chen Z, Zhang X, Ardestani M M, et al. Prediction of in vivo joint mechanics of an artificial knee implant using rigid multi-body dynamics with elastic contacts. Proc Inst Mech Eng H, 2014, 228(6): 564-575.
21.	Shu L, Hashimoto S, Sugita N. Enhanced In-Silico polyethylene wear simulation of total knee replacements during daily activities. Ann Biomed Eng, 2021, 49(1): 322-333.
22.	Brockett C L, Abdelgaied A, Haythornthwaite T, et al. The influence of simulator input conditions on the wear of total knee replacements: An experimental and computational study. Proc Inst Mech Eng H, 2016, 230(5): 429-439.
23.	Kang K-T, Son J, Kwon S K, et al. Preservation of femoral and tibial coronal alignment to improve biomechanical effects of medial unicompartment knee arthroplasty: Computational study. Biomed Mater Eng, 2018, 29(5): 651-664.
24.	Koh Y G, Park K M, Kang K, et al. Finite element analysis of the influence of the posterior tibial slope on mobile-bearing unicompartmental knee arthroplasty. Knee, 2021, 29: 116-125.
25.	O'Brien S, Luo Y, Wu C, et al. Prediction of backside micromotion in total knee replacements by finite element simulation. Proc Inst Mech Eng H, 2012, 226(3): 235-245.
26.	Abdelgaied A, Fisher J, Jennings L M. A comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements. J Mech Behav Biomed Mater, 2018, 78: 282-291.
27.	Pourzal R, Cip J, Rad E, et al. Joint line elevation and tibial slope are associated with increased polyethylene wear in cruciate-retaining total knee replacement. J Orthop Res, 2020, 38(7): 1596-1606.
28.	Powers C M, Chen Y-J, Scher I, et al. The influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces. J Biomech, 2006, 39(15): 2783-2791.
29.	Kowalczewski J B, Labey L, Chevalier Y, et al. Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis. Arch Med Sci, 2015, 11(2): 311-318.
30.	Takayama K, Ishida K, Muratsu H, et al. The medial tibial joint line elevation over 5mm restrained the improvement of knee extension angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1737-1742.
31.	Jeffcote B, Nicholls R, Schirm A, et al. The variation in medial and lateral collateral ligament strain and tibiofemoral forces following changes in the flexion and extension gaps in total knee replacement. A laboratory experiment using cadaver knees. J Bone Joint Surg Br, 2007, 89(11): 1528-1533.
32.	Zhang J, Chen Z, Wang L, et al. A patient-specific wear prediction framework for an artificial knee joint with coupled musculoskeletal multibody-dynamics and finite element analysis. Tribol Int, 2017, 109: 382-389.

1. Berger R A, Meneghini R M, Jacobs J J, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am, 2005, 87(5): 999-1006.
2. Lombardi A V, Berend K R, Walter C A, et al. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?. Clin Orthop Relat Res, 2009, 467(6): 1450-1457.
3. Beard D J Jr, Price A J, Cook J, et al. Total or partial knee replacement for medial osteoarthritis? early results from the TOPKAT trial. Arthroscopy, 2017, 33(10): 91-92.
4. Calkins T E, Hannon C P, Fillingham Y A, et al. Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4-19 years of follow-up: a concise follow-up of a previous report. J Arthroplasty, 2021, 36(3): 917-921.
5. Patil S, Colwell C W Jr, Ezzet K A, et al. Can normal knee kinematics be restored with unicompartmental knee replacement?. J Bone Joint Surg Am, 2005, 87(2): 332-338.
6. Koh Y G, Lee J A, Lee H Y, et al. Computational wear prediction of insert conformity and material on mobile-bearing unicompartmental knee arthroplasty. Bone joint Res, 2019, 8(11): 563-569.
7. Lee S Y, Bae J H, Kim J G, et al. The influence of surgical factors on dislocation of the meniscal bearing after Oxford medial unicompartmental knee replacement: a case-control study. Bone Joint J, 2014, 96-B(7): 914-922.
8. Rajgopal A, Panda I, Tyagi V C. Early failure with massive metallosis and posteromedial wear following atraumatic anterior cruciate ligament rupture after medial unicompartmental knee arthroplasty. Arthroplast Today, 2018, 4(1): 15-19.
9. Lo Presti M, Raspugli G F, Reale D, et al. Early failure in medial unicondylar arthroplasty: radiographic analysis on the importance of joint line restoration. J Knee Surg, 2019, 32(9): 860-865.
10. Flören M, Davis J, Peterson M G, et al. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty, 2007, 22(6 Suppl 2): 51-57.
11. Ensini A, Catani F, Biasca N, et al. Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 495-502.
12. Kwon O R, Kang K T, Son J, et al. Importance of joint line preservation in unicompartmental knee arthroplasty: finite element analysis. J Orthop Res, 2017, 35(2): 347-352.
13. Kang K-T, Kwon O-R, Son J, et al. Effect of joint line preservation on mobile-type bearing unicompartmental knee arthroplasty: finite element analysis. Australas Phys Eng Sci Med, 2018, 41(1): 201-208.
14. Pellikaan P, Van Der Krogt M M, Carbone V, et al. Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity. J Biomech, 2014, 47(5): 1144-1150.
15. Andersen M S, Rasmussen J. Total knee replacement musculoskeletal model using a novel simulation method for non-conforming joints// Proceedings of the International Society of Biomechanics Conference(ISBS). Belgium: International Society of Biomechanics, 2011.
16. Blankevoort L, Huiskes R, De Lange A. Recruitment of knee joint ligaments. J Biomech Eng, 1991, 113(1): 94-103.
17. Thelen D G, Won Choi K, Schmitz A M. Co-simulation of neuromuscular dynamics and knee mechanics during human walking. J Biomech Eng, 2014, 136(2): 021033.
18. Blankevoort L, Kuiper J H, Huiskes R, et al. Articular contact in a three-dimensional model of the knee. J Biomech, 1991, 24(11): 1019-1031.
19. Chen Z, Zhang Z, Wang L, et al. Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty. Med Eng Phys, 2016, 38(8): 708-716.
20. Chen Z, Zhang X, Ardestani M M, et al. Prediction of in vivo joint mechanics of an artificial knee implant using rigid multi-body dynamics with elastic contacts. Proc Inst Mech Eng H, 2014, 228(6): 564-575.
21. Shu L, Hashimoto S, Sugita N. Enhanced In-Silico polyethylene wear simulation of total knee replacements during daily activities. Ann Biomed Eng, 2021, 49(1): 322-333.
22. Brockett C L, Abdelgaied A, Haythornthwaite T, et al. The influence of simulator input conditions on the wear of total knee replacements: An experimental and computational study. Proc Inst Mech Eng H, 2016, 230(5): 429-439.
23. Kang K-T, Son J, Kwon S K, et al. Preservation of femoral and tibial coronal alignment to improve biomechanical effects of medial unicompartment knee arthroplasty: Computational study. Biomed Mater Eng, 2018, 29(5): 651-664.
24. Koh Y G, Park K M, Kang K, et al. Finite element analysis of the influence of the posterior tibial slope on mobile-bearing unicompartmental knee arthroplasty. Knee, 2021, 29: 116-125.
25. O'Brien S, Luo Y, Wu C, et al. Prediction of backside micromotion in total knee replacements by finite element simulation. Proc Inst Mech Eng H, 2012, 226(3): 235-245.
26. Abdelgaied A, Fisher J, Jennings L M. A comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements. J Mech Behav Biomed Mater, 2018, 78: 282-291.
27. Pourzal R, Cip J, Rad E, et al. Joint line elevation and tibial slope are associated with increased polyethylene wear in cruciate-retaining total knee replacement. J Orthop Res, 2020, 38(7): 1596-1606.
28. Powers C M, Chen Y-J, Scher I, et al. The influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces. J Biomech, 2006, 39(15): 2783-2791.
29. Kowalczewski J B, Labey L, Chevalier Y, et al. Does joint line elevation after revision knee arthroplasty affect tibio-femoral kinematics, contact pressure or collateral ligament lengths? An in vitro analysis. Arch Med Sci, 2015, 11(2): 311-318.
30. Takayama K, Ishida K, Muratsu H, et al. The medial tibial joint line elevation over 5mm restrained the improvement of knee extension angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1737-1742.
31. Jeffcote B, Nicholls R, Schirm A, et al. The variation in medial and lateral collateral ligament strain and tibiofemoral forces following changes in the flexion and extension gaps in total knee replacement. A laboratory experiment using cadaver knees. J Bone Joint Surg Br, 2007, 89(11): 1528-1533.
32. Zhang J, Chen Z, Wang L, et al. A patient-specific wear prediction framework for an artificial knee joint with coupled musculoskeletal multibody-dynamics and finite element analysis. Tribol Int, 2017, 109: 382-389.

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