Contact pressure of knee prosthesis under different loads with deviation angles by finite element analysis

doi:10.3969/j.issn.2095-4344.1471

Abstract

Abstract:

BACKGROUND: After artificial knee joint replacement, some patients have low postoperative satisfaction because of the failure of the prosthesis. The early failure of the knee prosthesis is caused by the early wear of the polyethylene component, the loosening and the instability of the prosthesis, which are affected by the contact pressure of the prosthesis.

OBJECTIVE: To study the effect of load offset angle on contact pressure, contact area and contact pressure distribution on the polyethylene insert during gait circle.

METHODS: The model of the knee prosthesis was introduced into the Abaqus three-dimensional finite element software. The axial force of gait load was offset by 0°, 1°, 2°, 3°, 4°, 5° and 6° to form seven working conditions. The contact pressure, contact area and contact pressure distribution of the polyethylene insert were studied under different working conditions.

RESULTS AND CONCLUSION: (1) The contact pressure of the polyethylene insert increases with the augment of the axial load deviation angle during the gait circle. (2) As the axial load shifting to the outside, the contact area between the polyethylene insert and the medial condyle decreases, and the contact area with the lateral condyle increases. (3) Through the contact pressure distribution cloud map, it is found that the contact position gradually moves toward the edge of the tibial tray, and stress concentration occurs at the contact position between the tibial tray and the lateral condyle. (4) The load deviation caused by the poor malalignment will cause the contact pressure on the polyethylene component to increase significantly, and will change the original contact area and contact position. If the knee prosthesis is in the above-mentioned poor mechanical environment for a long time, it will lead to the failure of the knee prosthesis.

Key words: artificial knee joint, finite element analysis, gait circle, contact pressure, contact area, biomechanics, National Natural Science Foundation of China

CLC Number:

R445|R318.01|R684

Xiang Changxin, Ji Binping, Chen Weiyi, Wang Changjiang, Guo Yuan. Contact pressure of knee prosthesis under different loads with deviation angles by finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4522-4528.

Figures/Tables 2

采用上述方法使用Abaqus软件进行有限元模拟分析。在步态过程中，将轴向载荷相对于中立位分别偏移0°，1°，2°，3°，4°，5°与6°形成7种不同工况，得到不同工况下的接触压力，面积与位置的变化。 2.1 接触压力在步态过程中，不同工况下的胫骨垫衬上接触压力变化见图6。此文在0°工况下的接触压力最大值为22.92 MPa，这与Gruionu等[33]的研究结果一致，表明该有限元模型的准确性，接触压力的最大值出现在高分子聚乙烯垫衬内侧髁。此次研究采用与Halloran等[25]相同的步态数据，其研究表明在步态过程进行到44%和55%时，接触压力分别为20 MPa和19.1 MPa。同样工况下，此次研究得到的接触压力分别为22.60 MPa和18.64 MPa，此文的中0°工况下接触压力曲线和Halloran等[25]接触压力曲线在趋势上相同，都是在步态过程进行到14%与44%时到达2次峰值，进一步证明了模拟结果的有效性。通过对比曲线，可以得到在步态周期进行到达14%时，不同工况下的胫骨垫衬上的接触压力均达到最大值，0°，1°，2°，3°，4°，5°和6°工况下，其接触压力最大值分别为22.92 MPa，25.84 MPa，27.44 MPa，27.56 MPa，29.67 MPa，33.06 MPa和37.37 MPa。当步态过程达到摆动期后，不同工况下的接触压力都随步态的进行呈现波动性变化。通过对比其他工况和0°工况的接触压力曲线，可以发现，在步态过程中轴向载荷偏移角度的增大会使胫骨垫衬上接触压力明显增大。 2.2 接触面积在步态过程中，不同工况下胫骨垫衬与股骨假体内外侧髁的接触面积变化见图7。由图可知，在步态过程中的站立期(0-60%)，在0°工况下胫骨垫衬与内侧髁的接触面积大于其与外侧髁的接触面积，胫骨垫衬与膝关节假体内外侧髁的接触面积随步态过程的进行而呈现明显变化。发现在0°工况和1°工况下接触面积结果相似，当偏移角度达到3°以上时，同一个工况下在步态进程从20%-30%时，外侧髁与胫骨垫衬的接触面积会逐渐大于内侧髁与胫骨垫片的接触面积。在步态站立期，0°工况下外侧髁与胫骨垫衬接触面积的最大值为108.80 mm2，最小值为46.77 mm2；内侧髁与胫骨垫衬接触面积的最大值为128.41 mm2，最小值为58.28 mm2。6°工况下外侧髁与胫骨垫衬接触面积的最大值为106.52 mm2，最小值为57.17 mm2；内侧髁与胫骨垫衬接触面积的最大值113.62 mm2，最小值为48.62 mm2。"

References

[1]Goudie EB, Robinson C, Walmsley P, et al. Changing trends in total knee replacement. Eur J Orthop Surg Traumatol. 2017;27(4):539-544.

[2]Nam D, Mcarthur BA, Cross MB, et al. Patient-specific instrumentation in total knee arthroplasty: a review. J Knee Surg. 2012;25(3):213-220.

[3]Noble PC, Conditt MA, Cook KF, et al. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452(452):35-43.

[4]Massin P. How does total knee replacement technique influence polyethylene wear. Orthop Traumatol Surg Res. 2017; 103(1):S21.

[5]Werner FW, Ayers DC, Maletsky LP, et al. The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech. 2005;38(2):349-355.

[6]Martinelli N, Baretta S, Pagano J, et al. Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis. BMC Musculoskeletal Disorders. 2017;18(3):2473011417S0002.

[7]Cerquiglini A, Henckel J, Hothi HS, et al. Computed tomography techniques help understand wear patterns in retrieved total knee arthroplasty. J Arthroplasty. 2018;33(9):3030-3037.

[8]Villa TMF, Gastaldi D, Colombo M, et al. Contact stresses and fatigue life in a knee prosthesis: comparison between in vitro measurements and computational simulations. J Biomech. 2004;37(1):45-53.

[9]Goswami T. Knee implants-Review of models and biomechanics. Mater Des. 2009;30(2):398-413.

[10]Bartel DL, Rawlinson JJ, Burstein AH, et al. Stresses in polyethylene components of contemporary total knee replacements. Clin Orthop Relat Res. 1995;317(317):76-82.

[11]Collier JP, Mayor MB, Mcnamara JL, et al. Analysis of the Failure of 122 Polyethylene Inserts From Uncemented Tibial Knee Components. Clin Orthop Relat Res. 1991;273(273):232-242.

[12]Stukenborgcolsman C, Ostermeier S, Hurschler C, et al. Tibiofemoral contact stress after total knee arthroplasty: comparison of fixed and mobile-bearing inlay designs. Acta Orthopaedica Scandinavica. 2002; 73(6):638-646.

[13]Sathasivam S, Walker PS. Computer model to predict subsurface damage in tibial inserts of total knees. J Orthop Res. 2010;16(5):564.

[14]莫富灏,杜敏,刘傥,等. 肿瘤型膝关节置换后股骨-假体-胫骨复合体生物力学响应[J]. 医用生物力学,2016,31(3):235-239.

[15]Woiczinski M, Steinbrück A, Weber P, et al. Development and validation of a weight-bearing finite element model for total knee replacement. Comput Methods Biomech Biomed Engin. 2016;19(10): 1033-1045.

[16]Nakamura S , Tian Y , Tanaka Y , et al. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia. Bone Joint Res. 2017;6(1):43-51.

[17]Young SW, Koh CK, Ravi S, et al. Total knee arthroplasty in the 21st century: why do they fail? a fifteen-year analysis of 11, 135 knees. Orthop J Sports Med. 2017;5(5 suppl5):2325967117S0020.

[18]Barbour PS, Barton DC, Fisher J. The influence of stress conditions on the wear of UHMWPE for total joint replacements. J Mater Sci Mater Med. 1997;8(10):603.

[19]郭媛,张绪树,安美文,等. 日常运动时内翻人工膝关节接触压力的有限元分析[J]. 太原理工大学学报,2014,45(3):358-362.

[20]Shi JF. Finite element analysis of total knee replacement considering gait cycle load and malalignment. Quaternary Sci. 2007;27(5): 870-879.

[21]Li X, Wang C, Guo Y, et al. An approach to developing customized total knee replacement implants. J Health Eng. 2017; 2017(8):1-8.

[22]Munzinger UK , Wyss U , Boldt JG , et al. Basic Science, Design, and Materials[M]// Primary Knee Arthroplasty. Springer Berlin Heidelberg, 2004.

[23]Teo A, Mishra A, Park I, et al. Polymeric Biomaterials for Medical Implants & Devices. Acs Biomat Sci Eng. 2016; 2(4): 454-472.

[24]张绪树,郭媛,安美文,等. 不同运动状态下国产人工膝关节接触压力分布有限元分析[J]. 计算机辅助工程,2013,22(2):61-65.

[25]Halloran JP, Petrella AJ, Rullkoetter PJ. Explicit finite element modeling of total knee replacement mechanics. J Biomech. 2005; 38(2):323-331.

[26]李新宇,王长江,陈维毅. 一种新型膝关节假体在步态过程中接触应力的有限元仿真[J]. 医用生物力学,2017,32(6):494-499.

[27]崔晓倩,王辅忠,张慧春. 膝关节股骨远端软骨硬化前后力学性能分析[J]. 医用生物力学,2015,30(1):25-29.

[28]Crowninshield R, Pope MH, Johnson RJ. An analytical model of the knee. J Biomech. 1976;9(6):397-405.

[29]王俊然,杜玮瑾,王长江,等. 有限元分析不同屈曲状态下胫-股关节的生物力学变化[J]. 中国组织工程研究,2018,22(31):4975-4981.

[30]Taylor M, Barrett DS. Explicit finite element simulation of eccentric loading in total knee replacement. Clin Orthop Relat Res. 2003;414 (414):162-171.

[31]ISO, ISO 14243-3: 2014, Implants for Surgery-Wear of Total Knee-Joint Prostheses, Loading and Displacement Parameters for Wear-Testing Machines with Displacement Control and Corresponding Environmental Conditions for Test, International Organization Environmental Standardization, London, UK, 2014.

[32]Lafortune MA, Cavanagh PR, Iii HJS, et al. Three-dimensional kinematics of the human knee during walking. J Biomech. 1992;25(4): 347-357.

[33]Gruionu LG, Gruionu G, Pastrama S, et al. Contact studies between total knee replacement components developed using explicit finite elements analysis.[C]// International Conference on Medical Image Computing & Computer-assisted Intervention. 2009.

[34]赵奇,蒋垚. 人工膝关节假体设计新进展[J]. 中国组织工程研究,2010, 14(52):9838-9840.

[35]邓海宁,曹轲飞,蒋仕雄. 全膝关节置换术假体的三维有限元生物力学分析[J]. 基因组学与应用生物学,2017,36(12):4992-4999.

[36]Nguyen LCL, Lehil MS, Bozic KJ. Trends in total knee arthroplasty implant utilization. J Arthroplasty. 2015;30(5):739-742.

[37]Nakamura S, Tian Y, Tanaka Y, et al. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia:A case study for varus knee. Bone Joint Res. 2017;6(1):43-51.

[38]Vince KG. Why knees fail. J Arthroplasty. 2003;18(1):39-44.

[39]Brockett C, Carbone S, Fisher J, et al. Influence of conformity on the wear of total knee replacement: An experimental study. Proc Inst Mech Eng H. 2018;232(2):127-134.

[40]D'Lima DD, Chen PC, Jr CC. Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res. 2001;392(392): 232-238.

[41]Rivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2017; 103(7):1047.

[42]Affatato S, Valigi MC, Logozzo S. Wear distribution detection of knee joint prostheses by means of 3d optical scanners. Materials. 2017;10(4):36.

[43]Tarni?? D, Calafeteanu DM, Geonea ID, et al. Effects of malalignment angle on the contact stress of knee prosthesis components, using finite element method. Rom J Morphol Embryol. 2017;58(3):831-836.

[44]Brockett CL, 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.