Effects of elastic modulus of the metal block on the condylar-constrained knee prosthesis tibial fixation stability_Journal of Biomedical Engineering

Authors：

ZHANG Yuhan ¹ ,  ZHANG Jing ¹ , DONG Tianqi ¹ , ZHANG Xuan ¹ , ZHANG Weijie ² , GUO Lei ¹ , 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：

ZHANG Jing, Email: zhangjing@chd.edu.cn

Keywords：

Constrained condylar knee prosthesis; Metal block; Finite element analysis; Fixation stability

DOI：

10.7507/1001-5515.202410039

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Although metal blocks have been widely used for reconstructing uncontained tibial bone defects, the influence of their elastic modulus on the stability of tibial prosthesis fixation remains unclear. Based on this, a finite element model incorporating constrained condylar knee (CCK) prosthesis, tibia, and metal block was established. Considering the influence of the post-restraint structure of the prosthesis, the effects of variations in the elastic modulus of the block on the von Mises stress distribution in the tibia and the block, as well as on the micromotion at the bone-prosthesis fixation interface, were investigated. Results demonstrated that collision between the insert post and femoral prosthesis during tibial internal rotation increased tibial von Mises stress, significantly influencing the prediction of block elastic modulus variation. A decrease in the elastic modulus of the metal block resulted in increased von Mises stress in the proximal tibia, significantly reduced von Mises stress in the distal tibia, decreased von Mises stress of the block, and increased micromotion at the bone-prosthesis fixation interface. When the elastic modulus of the metal block fell below that of bone cement, inadequate block support substantially increased the risk of stress shielding in the distal tibia and fixation interface loosening. Therefore, this study recommends that biomechanical investigations of CCK prostheses must consider the post-constraint effect, and the elastic modulus of metal blocks for bone reconstruction should not be lower than 3 600 MPa.

Citation： ZHANG Yuhan, ZHANG Jing, DONG Tianqi, ZHANG Xuan, ZHANG Weijie, GUO Lei, CHEN Zhenxian. Effects of elastic modulus of the metal block on the condylar-constrained knee prosthesis tibial fixation stability. Journal of Biomedical Engineering, 2025, 42(4): 782-789. doi: 10.7507/1001-5515.202410039 Copy

1.	Athal K K, Willinger L, Manning W, et al. A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 659-667.
2.	Villa J M, Mashni S J, Bains S S, et al. The fate of highly porous titanium tibial cones in revision totalknee arthroplasty: a multicenter 5-year minimum follow-up study. J Arthroplasty, 2025: S0883.
3.	梁浩東, 潘建科, 謝輝, 等. 全膝關節置換過程中骨缺損的處理策略. 中國組織工程研究, 2018, 22(15): 2414-2420.
4.	束志勇, 查振剛, 李劼若, 等. 全膝關節翻修術中骨缺損的治療進展. 中國矯形外科雜志, 2008, 16(24): 1879-1882.
5.	Zhang J, Liu Y, Han Q, et al. Biomechanical comparison between porous Ti6Al4V block and tumor prosthesis UHMWPE block for the treatment of distal femur bone defects. Front Bioeng Biotechnol, 2022, 10: 939371.
6.	Shafagih R, Rodriguez O, Schemitsch E H, et al. A review of materials for managing bone loss in revision total knee arthroplasty. Mater Sci Eng C, 2019, 104: 109941.
7.	Innocenti B, Fekete G, Pianigiani S. Biomechanical analysis of augments in revision total knee arthroplasty. J Biomech Eng, 2018, 140(11): 111006.
8.	Liu Y, Chen B, Wang C, et al. Design of porous metal block augmentation to treat tibial bone defects in total knee arthroplasty based on topology optimization. Front Bioeng Biotechnol, 2021, 9: 765438.
9.	Rahimizadeh A, Nourmohammadi Z, Arabnejad D S, et al. Porous architected biomaterial for a tibial-knee implant with minimum bone resorption and bone-implant interface micromotion. J Mech Behav Biomed Mater, 2018, 78: 465-479.
10.	Yoon J R, Cheong J Y, Im J T, et al. Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: a meta-analysis. PLoS ONE, 2019, 14(3): e0214279.
11.	Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
12.	Annur D, Kartika I, Sudiro T, et al. Microstructure, mechanical properties, and in vitro studies of porous titanium obtained by spark plasma sintering. Trans Indian Inst Met, 2022, 75(12): 3067-3076.
13.	Liang D, Zhong C, Jiang F, et al. Fabrication of porous tantalum with low elastic modulus and tunable pore size for bone repair. ACS Biomaterials Science & Engineering, 2023, 9(3): 1720-1728.
14.	趙志慶, 王冀川, 燕太強, 等. 3D打印踝關節融合假體重建脛骨遠端腫瘤切除后骨缺損的有限元分析. 中國骨與關節雜志, 2023, 12(12): 883-888.
15.	陳彥飛, 魯超, 趙勇, 等. 基于CT影像動態膝關節有限元模型的構建及仿真力學分析. 中國骨傷, 2020, 33(5): 479-484.
16.	胡海波, 劉會群, 王杰恩, 等. 生物醫用多孔鈦及鈦合金的研究進展. 材料導報, 2012, 26(1): 262-266,270.
17.	Godest A C, Beaugonin M, Haug E, et al. Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis. J Biomech, 2002, 35(2): 267-275.
18.	Kelly N, Cawley D T, Shannon F J, et al. An investigation of the inelastic behaviour of trabecular bone during the press-fit implantation of a tibial component in total knee arthroplasty. Med Eng Phys, 2013, 35(11): 1599-1606.
19.	International Organization for Standardization. ISO 14243-3: 2014 Implants for surgery-Wear of total knee-joint prostheses-Part 3: Loading and displacement parameters for wear-testing machines with displacement control and corresponding environmental conditions for test. Geneva: International Organization for Standardization, 2014.
20.	Greenberg A, Cohen D, Shahabinezhad A, et al. Good short-term survivorship of constrained condylar revision knee implants with medial pivot kinematics: a level IV retrospective study. J Arthroplasty, 2024, 39(8 S1): S275-S279.
21.	Wang X, Malik A, Bartel D L, et al. Load sharing among collateral ligaments, articular surfaces, and the tibial post in constrained condylar knee arthroplasty. J Biomech Eng, 2016, 138(8): 081002.
22.	Chen Z, Han J, Zhang J, et al. Tibial post loading increases the risk of aseptic loosening of posterior-stabilized tibial prosthesis. Proc Inst Mech Eng H, 2024, 238(8-9): 886-896.
23.	趙光輝, 馬建兵, 王建朋. 初次全膝關節置換術中使用短延長桿的生物力學研究. 中華骨與關節外科雜志, 2023, 16(8): 713-720.
24.	Totoribe K, Chosa E, Yamako G, et al. Finite element analysis of the tibial bone graft in cementless total knee arthroplasty. J Orthop Surg Res, 2018, 13(1): 113.
25.	Cameron H U, Pilliar R M, Macnab I. The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res, 1973, 7(4): 301-311.
26.	Engh C A, O'connor D, Jasty M, et al. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res, 1992, 285: 13-29.
27.	El-zayat B F, Heyse T J, Fanciullacci N, et al. Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study. Arch Orthop Trauma Surg, 2016, 136(12): 1741-1752.
28.	Barrack R L, Stanley T, Burt M, et al. The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty, 2004, 19(7 Suppl 2): 119-124.

1. Athal K K, Willinger L, Manning W, et al. A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 659-667.
2. Villa J M, Mashni S J, Bains S S, et al. The fate of highly porous titanium tibial cones in revision totalknee arthroplasty: a multicenter 5-year minimum follow-up study. J Arthroplasty, 2025: S0883.
3. 梁浩東, 潘建科, 謝輝, 等. 全膝關節置換過程中骨缺損的處理策略. 中國組織工程研究, 2018, 22(15): 2414-2420.
4. 束志勇, 查振剛, 李劼若, 等. 全膝關節翻修術中骨缺損的治療進展. 中國矯形外科雜志, 2008, 16(24): 1879-1882.
5. Zhang J, Liu Y, Han Q, et al. Biomechanical comparison between porous Ti6Al4V block and tumor prosthesis UHMWPE block for the treatment of distal femur bone defects. Front Bioeng Biotechnol, 2022, 10: 939371.
6. Shafagih R, Rodriguez O, Schemitsch E H, et al. A review of materials for managing bone loss in revision total knee arthroplasty. Mater Sci Eng C, 2019, 104: 109941.
7. Innocenti B, Fekete G, Pianigiani S. Biomechanical analysis of augments in revision total knee arthroplasty. J Biomech Eng, 2018, 140(11): 111006.
8. Liu Y, Chen B, Wang C, et al. Design of porous metal block augmentation to treat tibial bone defects in total knee arthroplasty based on topology optimization. Front Bioeng Biotechnol, 2021, 9: 765438.
9. Rahimizadeh A, Nourmohammadi Z, Arabnejad D S, et al. Porous architected biomaterial for a tibial-knee implant with minimum bone resorption and bone-implant interface micromotion. J Mech Behav Biomed Mater, 2018, 78: 465-479.
10. Yoon J R, Cheong J Y, Im J T, et al. Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: a meta-analysis. PLoS ONE, 2019, 14(3): e0214279.
11. Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
12. Annur D, Kartika I, Sudiro T, et al. Microstructure, mechanical properties, and in vitro studies of porous titanium obtained by spark plasma sintering. Trans Indian Inst Met, 2022, 75(12): 3067-3076.
13. Liang D, Zhong C, Jiang F, et al. Fabrication of porous tantalum with low elastic modulus and tunable pore size for bone repair. ACS Biomaterials Science & Engineering, 2023, 9(3): 1720-1728.
14. 趙志慶, 王冀川, 燕太強, 等. 3D打印踝關節融合假體重建脛骨遠端腫瘤切除后骨缺損的有限元分析. 中國骨與關節雜志, 2023, 12(12): 883-888.
15. 陳彥飛, 魯超, 趙勇, 等. 基于CT影像動態膝關節有限元模型的構建及仿真力學分析. 中國骨傷, 2020, 33(5): 479-484.
16. 胡海波, 劉會群, 王杰恩, 等. 生物醫用多孔鈦及鈦合金的研究進展. 材料導報, 2012, 26(1): 262-266,270.
17. Godest A C, Beaugonin M, Haug E, et al. Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis. J Biomech, 2002, 35(2): 267-275.
18. Kelly N, Cawley D T, Shannon F J, et al. An investigation of the inelastic behaviour of trabecular bone during the press-fit implantation of a tibial component in total knee arthroplasty. Med Eng Phys, 2013, 35(11): 1599-1606.
19. International Organization for Standardization. ISO 14243-3: 2014 Implants for surgery-Wear of total knee-joint prostheses-Part 3: Loading and displacement parameters for wear-testing machines with displacement control and corresponding environmental conditions for test. Geneva: International Organization for Standardization, 2014.
20. Greenberg A, Cohen D, Shahabinezhad A, et al. Good short-term survivorship of constrained condylar revision knee implants with medial pivot kinematics: a level IV retrospective study. J Arthroplasty, 2024, 39(8 S1): S275-S279.
21. Wang X, Malik A, Bartel D L, et al. Load sharing among collateral ligaments, articular surfaces, and the tibial post in constrained condylar knee arthroplasty. J Biomech Eng, 2016, 138(8): 081002.
22. Chen Z, Han J, Zhang J, et al. Tibial post loading increases the risk of aseptic loosening of posterior-stabilized tibial prosthesis. Proc Inst Mech Eng H, 2024, 238(8-9): 886-896.
23. 趙光輝, 馬建兵, 王建朋. 初次全膝關節置換術中使用短延長桿的生物力學研究. 中華骨與關節外科雜志, 2023, 16(8): 713-720.
24. Totoribe K, Chosa E, Yamako G, et al. Finite element analysis of the tibial bone graft in cementless total knee arthroplasty. J Orthop Surg Res, 2018, 13(1): 113.
25. Cameron H U, Pilliar R M, Macnab I. The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res, 1973, 7(4): 301-311.
26. Engh C A, O'connor D, Jasty M, et al. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res, 1992, 285: 13-29.
27. El-zayat B F, Heyse T J, Fanciullacci N, et al. Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study. Arch Orthop Trauma Surg, 2016, 136(12): 1741-1752.
28. Barrack R L, Stanley T, Burt M, et al. The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty, 2004, 19(7 Suppl 2): 119-124.

Previous Article
Simulation analysis of adaptability of large airborne negative pressure isolation cabin to aviation conditions
Next Article
Design and analysis of human arm pathological tremor simulation system

Journal of Biomedical Engineering

Effects of elastic modulus of the metal block on the condylar-constrained knee prosthesis tibial fixation stability

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content