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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2009 | Research article

Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study

Authors: Bernardo Innocenti, Evelyn Truyens, Luc Labey, Pius Wong, Jan Victor, Johan Bellemans

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2009

Abstract

Background

Asymptomatic local bone resorption of the tibia under the baseplate can occasionally be observed after total knee arthroplasty (TKA). Its occurrence is not well documented, and so far no explanation is available. We report the incidence of this finding in our practice, and investigate whether it can be attributed to specific mechanical factors.

Methods

The postoperative radiographs of 500 consecutive TKA patients were analyzed to determine the occurrence of local medial bone resorption under the baseplate. Based on these cases, a 3D FE model was developed. Cemented and cementless technique, seven positions of the baseplate and eleven load sharing conditions were considered. The average VonMises stress was evaluated in the bone-baseplate interface, and the medial and lateral periprosthetic region.

Results

Sixteen cases with local bone resorption were identified. In each, bone loss became apparent at 3 months post-op and did not increase after one year. None of these cases were symptomatic and infection screening was negative for all. The FE analysis demonstrated an influence of baseplate positioning, and also of load sharing, on stresses. The average stress in the medial periprosthetic region showed a non linear decrease when the prosthetic baseplate was shifted laterally. Shifting the component medially increased the stress on the medial periprosthetic region, but did not significantly unload the lateral side. The presence of a cement layer decreases the stresses.

Conclusion

Local bone resorption of the proximal tibia can occur after TKA and might be attributed to a stress shielding effect. This FE study shows that the medial periprosthetic region of the tibia is more sensitive than the lateral region to mediolateral positioning of the baseplate. Medial cortical support of the tibial baseplate is important for normal stress transfer to the underlying bone. The absence of medial cortical support of the tibial baseplate may lead to local bone resorption at the proximal tibia, as a result of the stress shielding effect. The presence of a complete layer of cement can reduce stress shielding, though. Despite the fact that the local bone resorption is asymptomatic and non-progressive, surgeons should be aware of this phenomenon in their interpretation of follow-up radiographs.

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Title: Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study
Authors: Bernardo Innocenti
Evelyn Truyens
Luc Labey
Pius Wong
Jan Victor
Johan Bellemans
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2009
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/1749-799X-4-26

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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