The influence of articular surface conformity on the biomechanics of rotating hinge knee prostheses_Journal of Biomedical Engineering

Authors：

LI Ying ¹ ,  ZHANG Zhifeng ² , LI Longhui ¹ , ZHANG Jing ¹ , CHEN Zhenxian ¹ , ZHANG Weijie ³

1. School of Construction Machinery, Chang’an University, Xi’an 710064, P. R. China;
2. Department of Joint Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Orthopedic Research Institute of Inner Mongolia Autonomous Region, Hohhot 010110, P. R. China;
3. Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi’an 710054, P. R. China;

Corresponding?author：

ZHANG Zhifeng, Email: longxianglvzhe@163.com

Keywords：

Rotating hinge knee prosthesis; Movable tibial insert; Conformity; Finite element analysis; Biomechanics

DOI：

10.7507/1001-5515.202509058

Video：

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Abstract Full text Figures/Tables Video References Cited by

Articular surface conformity is a critical factor influencing the biomechanics of knee prostheses, yet its impact on the biomechanics of rotation-hinged knee (RHK) prostheses and their tibial fixation remains unclear. In this study, a rotational platform tibial insert model of RHK prostheses with varying coronal and sagittal conformities is established. Finite element analysis was performed under ISO boundary conditions to investigate the effects of articular surface conformity on the biomechanics of the RHK prosthesis and tibial fixation. The study revealed that when the coronal conformity decreased from 0.83 to 0.33, the maximum Mises stress in the tibia and the maximum contact pressure in the insert increased by 10.78% and 52.62%, respectively, while the maximum shear stress in the bone cement decreased by 10.17%. When sagittal conformity decreased from 0.88 to 0.47, the maximum Mises stress in the tibia and maximum contact pressure in the insert increased by 5.62% and 14.31%, respectively, while Mises stress at the hinge-rotation axis and bone cement shear stress decreased by 62.53% and 29.46%, respectively. A reduction in conformity decreased the contact area. Sagittal conformity has a lesser impact on insert contact pressure compared to coronal conformity, but a more significant impact on bone cement shear stress, and reducing sagittal conformity could effectively reduce the Mises stress at the hinge-rotation axis. The coronal conformity of the RHK prosthesis on the rotational platform more effectively regulates contact mechanics, reducing sagittal conformity facilitates lowering hinge-rotation axis Mises stress and bone cement shear stress without significantly increasing contact pressure, thereby mitigating risks of prosthesis failure such as dislocation, fracture, and loosening.

Citation： LI Ying, ZHANG Zhifeng, LI Longhui, ZHANG Jing, CHEN Zhenxian, ZHANG Weijie. The influence of articular surface conformity on the biomechanics of rotating hinge knee prostheses. Journal of Biomedical Engineering, 2026, 43(2): 235-241. doi: 10.7507/1001-5515.202509058 Copy

1.	Small S R, Rogge R D, Malinzak R A, et al. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs. Bone Joint Res, 2016, 5(4): 122-129.
2.	Dauwe J, Vandenneucker H. Indications for primary rotating-hinge total knee arthroplasty: is there consensus? Acta Orthop Belg, 2018, 84: 1-6.
3.	Oliver T C, Kayani B, Luo T D, et al. Current concepts in total knee arthroplasty: rotating hinge prostheses. SICOT J, 2025, 11: 18.
4.	Zhang J, Tian D, Ren Z, et al. Influence of congruency design on the contact stress of a novel hinged knee prosthesis using finite element analysis. Orthop Surg, 2020, 12(2): 631-638.
5.	Koh Y G, Son J, Kwon O R, et al. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1213-1223.
6.	宋春燕. 基于接觸力學的人工膝關節幾何參數優化研究. 太原: 中北大學, 2021.
7.	Zhang Q, Chen Z, Zhang J, et al. Insert conformity variation affects kinematics and wear performance of total knee replacements. Clin Biomech, 2019, 65: 19-25.
8.	王猛, 李興, 成博, 等. 膝關節假體脛骨襯墊幾何設計對其接觸力學和運動的影響. 中國組織工程研究, 2019, 23(18): 2794-2799.
9.	Sathasivam S, Walker P S. The conflicting requirements of laxity and conformity in total knee replacement. J Biomech, 1999, 32(3): 239-247.
10.	Luger E, Sathasivam S, Walker P S. Inherent differences in the laxity and stability between the intact knee and total knee replacements. Knee, 1997, 4(1): 7-14.
11.	Yang H, Behnam Y, Clary C, et al. Drivers of initial stability in cementless TKA: isolating effects of tibiofemoral conformity and fixation features. J Mech Behav Biomed Mater, 2022, 136: 105507.
12.	Ardestani M M, Moazen M, Maniei E, et al. Posterior stabilized versus cruciate retaining total knee arthroplasty designs: conformity affects the performance reliability of the design over the patient population. Med Eng Phys, 2015, 37(4): 350-360.
13.	Ardestani M M, Moazen M, Jin Z. Contribution of geometric design parameters to knee implant performance: conflicting impact of conformity on kinematics and contact mechanics. Knee, 2015, 22(3): 217-224.
14.	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.
15.	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.
16.	宋春燕, 劉峰, 李宏偉. 基于接觸力學的膝關節假體幾何參數研究. 機械設計與制造工程, 2021, 50(4): 8-12.
17.	Abdelgaied A, Liu F, Brockett C, et al. Computational wear prediction of artificial knee joints based on a new wear law and formulation. J Biomech, 2011, 44(6): 1108-1116.
18.	Wang X H, Li H, Dong X, et al. Comparison of ISO 14243-1 to ASTM F3141 in terms of wearing of knee prostheses. Clin Biomech, 2019, 63: 34-40.
19.	Zhang J, Chen Z, Gao Y, et al. Computational wear prediction for impact of kinematics boundary conditions on wear of total knee replacement using two cross-shear models. J Tribol, 2019, 141(11): 111201.
20.	W-Dahl A, K?rrholm J, Rogmark C, et al. Annual report 2022: the Swedish Arthroplasty Register. 2022 ed. G?teborg: The Swedish Arthroplasty Register, 2022.
21.	Galvin A L, Kang L, Udofia I, et al. Effect of conformity and contact stress on wear in fixed-bearing total knee prostheses. J Biomech, 2009, 42(12): 1898-1902.
22.	Lee K Y, Pienkowski D. Compressive creep characteristics of extruded ultrahigh-molecular-weight polyethylene. J Biomed Mater Res, 1998, 39(2): 261-265.
23.	Fisher J, Dowson D. Tribology of total artificial joints. Proc Inst Mech Eng H, 1991, 205(2): 73-79.
24.	Kornilov N N, et al. Dislocation of modern design rotating hinge total knee arthroplasty: case series and narrative review. Acta Orthop Belg, 2020, 86: 303-312.
25.	Quinlan N D, Wu Y, Chiaramonti A M, et al. Functional flexion instability after rotating-platform total knee arthroplasty. J Bone Joint Surg Am, 2020, 102(19): 1694-1702.
26.	Zhang M, Zhang K, Gong H. Biomechanical effects of tibial stems with different structures on human knee joint after total knee arthroplasty: a finite element analysis. J Bionic Eng, 2022, 19(1): 197-208.
27.	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.
28.	Su W L, You K D, Yang C C, et al. Stress analysis of improper femur cut in total knee arthroplasty by finite element method. J Mech, 2020, 36(3): 315-322.
29.	Giurea A, Neuhaus H J, Miehlke R, et al. Early results of a new rotating hinge knee implant. Biomed Res Int, 2014, 2014: 948520.
30.	Friesenbichler J, Schwarzkopf R, Sadoghi P, et al. Failure rate of a rotating hinge knee design due to yoke fracture of the hinged tibial insert: a retrospective data analysis and review of the literature. Int Orthop, 2012, 36(5): 993-998.
31.	Kawai A, Healey J H, Boland P J, et al. A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty, 1999, 14(2): 187-196.
32.	Barrientos-Ruiz I, Ortiz-Cruz E J, Peleteiro-Pensado M, et al. Early mechanical failure of a tumor endoprosthetic rotating hinge in the knee: does bumper wear contribute to hyperextension failure? Clin Orthop Relat Res, 2019, 477(12): 2718-2725.
33.	Springer B D, Sim F H, Hanssen A D, et al. The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res, 2004, 421: 181-187.
34.	Zuchuat J, Cura A, Manzano A, et al. CoCrMo alloy as biomaterial for bone reconstruction in oral and maxillofacial surgery: a scoping review. J Oral Res, 2020, 9(4): 336-349.
35.	Hayatbakhsh Z, Farahmand F, Karimpour M. Is a complete anatomical fit of TomoFix plate biomechanically favorable? a parametric study using finite element method. Arch Bone Joint Surg, 2022, 10(8): 712-720.
36.	Bergmann G, Bender A, Graichen F, et al. Standardized loads acting in knee implants. PLoS One, 2014, 9(1): e86035.
37.	Thompson S M, Yohuno D, Bradley W N, et al. Finite element analysis: a comparison of an all-polyethylene tibial implant and its metal-backed equivalent. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2560-2566.
38.	Malinzak R A, Small S R, Rogge R D, et al. The effect of rotating platform TKA on strain distribution and torque transmission on the proximal tibia. J Arthroplasty, 2014, 29(3): 541-547.
39.	Del-Valle-Mojica J, Alonso-Rasgado T, Jimenez-Cruz D, et al. Effect of femoral head size, subject weight, and activity level on acetabular cement mantle stress following total hip arthroplasty. J Orthop Res, 2019, 37(8): 1771-1783.

1. Small S R, Rogge R D, Malinzak R A, et al. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs. Bone Joint Res, 2016, 5(4): 122-129.
2. Dauwe J, Vandenneucker H. Indications for primary rotating-hinge total knee arthroplasty: is there consensus? Acta Orthop Belg, 2018, 84: 1-6.
3. Oliver T C, Kayani B, Luo T D, et al. Current concepts in total knee arthroplasty: rotating hinge prostheses. SICOT J, 2025, 11: 18.
4. Zhang J, Tian D, Ren Z, et al. Influence of congruency design on the contact stress of a novel hinged knee prosthesis using finite element analysis. Orthop Surg, 2020, 12(2): 631-638.
5. Koh Y G, Son J, Kwon O R, et al. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1213-1223.
6. 宋春燕. 基于接觸力學的人工膝關節幾何參數優化研究. 太原: 中北大學, 2021.
7. Zhang Q, Chen Z, Zhang J, et al. Insert conformity variation affects kinematics and wear performance of total knee replacements. Clin Biomech, 2019, 65: 19-25.
8. 王猛, 李興, 成博, 等. 膝關節假體脛骨襯墊幾何設計對其接觸力學和運動的影響. 中國組織工程研究, 2019, 23(18): 2794-2799.
9. Sathasivam S, Walker P S. The conflicting requirements of laxity and conformity in total knee replacement. J Biomech, 1999, 32(3): 239-247.
10. Luger E, Sathasivam S, Walker P S. Inherent differences in the laxity and stability between the intact knee and total knee replacements. Knee, 1997, 4(1): 7-14.
11. Yang H, Behnam Y, Clary C, et al. Drivers of initial stability in cementless TKA: isolating effects of tibiofemoral conformity and fixation features. J Mech Behav Biomed Mater, 2022, 136: 105507.
12. Ardestani M M, Moazen M, Maniei E, et al. Posterior stabilized versus cruciate retaining total knee arthroplasty designs: conformity affects the performance reliability of the design over the patient population. Med Eng Phys, 2015, 37(4): 350-360.
13. Ardestani M M, Moazen M, Jin Z. Contribution of geometric design parameters to knee implant performance: conflicting impact of conformity on kinematics and contact mechanics. Knee, 2015, 22(3): 217-224.
14. 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.
15. 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.
16. 宋春燕, 劉峰, 李宏偉. 基于接觸力學的膝關節假體幾何參數研究. 機械設計與制造工程, 2021, 50(4): 8-12.
17. Abdelgaied A, Liu F, Brockett C, et al. Computational wear prediction of artificial knee joints based on a new wear law and formulation. J Biomech, 2011, 44(6): 1108-1116.
18. Wang X H, Li H, Dong X, et al. Comparison of ISO 14243-1 to ASTM F3141 in terms of wearing of knee prostheses. Clin Biomech, 2019, 63: 34-40.
19. Zhang J, Chen Z, Gao Y, et al. Computational wear prediction for impact of kinematics boundary conditions on wear of total knee replacement using two cross-shear models. J Tribol, 2019, 141(11): 111201.
20. W-Dahl A, K?rrholm J, Rogmark C, et al. Annual report 2022: the Swedish Arthroplasty Register. 2022 ed. G?teborg: The Swedish Arthroplasty Register, 2022.
21. Galvin A L, Kang L, Udofia I, et al. Effect of conformity and contact stress on wear in fixed-bearing total knee prostheses. J Biomech, 2009, 42(12): 1898-1902.
22. Lee K Y, Pienkowski D. Compressive creep characteristics of extruded ultrahigh-molecular-weight polyethylene. J Biomed Mater Res, 1998, 39(2): 261-265.
23. Fisher J, Dowson D. Tribology of total artificial joints. Proc Inst Mech Eng H, 1991, 205(2): 73-79.
24. Kornilov N N, et al. Dislocation of modern design rotating hinge total knee arthroplasty: case series and narrative review. Acta Orthop Belg, 2020, 86: 303-312.
25. Quinlan N D, Wu Y, Chiaramonti A M, et al. Functional flexion instability after rotating-platform total knee arthroplasty. J Bone Joint Surg Am, 2020, 102(19): 1694-1702.
26. Zhang M, Zhang K, Gong H. Biomechanical effects of tibial stems with different structures on human knee joint after total knee arthroplasty: a finite element analysis. J Bionic Eng, 2022, 19(1): 197-208.
27. 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.
28. Su W L, You K D, Yang C C, et al. Stress analysis of improper femur cut in total knee arthroplasty by finite element method. J Mech, 2020, 36(3): 315-322.
29. Giurea A, Neuhaus H J, Miehlke R, et al. Early results of a new rotating hinge knee implant. Biomed Res Int, 2014, 2014: 948520.
30. Friesenbichler J, Schwarzkopf R, Sadoghi P, et al. Failure rate of a rotating hinge knee design due to yoke fracture of the hinged tibial insert: a retrospective data analysis and review of the literature. Int Orthop, 2012, 36(5): 993-998.
31. Kawai A, Healey J H, Boland P J, et al. A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty, 1999, 14(2): 187-196.
32. Barrientos-Ruiz I, Ortiz-Cruz E J, Peleteiro-Pensado M, et al. Early mechanical failure of a tumor endoprosthetic rotating hinge in the knee: does bumper wear contribute to hyperextension failure? Clin Orthop Relat Res, 2019, 477(12): 2718-2725.
33. Springer B D, Sim F H, Hanssen A D, et al. The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res, 2004, 421: 181-187.
34. Zuchuat J, Cura A, Manzano A, et al. CoCrMo alloy as biomaterial for bone reconstruction in oral and maxillofacial surgery: a scoping review. J Oral Res, 2020, 9(4): 336-349.
35. Hayatbakhsh Z, Farahmand F, Karimpour M. Is a complete anatomical fit of TomoFix plate biomechanically favorable? a parametric study using finite element method. Arch Bone Joint Surg, 2022, 10(8): 712-720.
36. Bergmann G, Bender A, Graichen F, et al. Standardized loads acting in knee implants. PLoS One, 2014, 9(1): e86035.
37. Thompson S M, Yohuno D, Bradley W N, et al. Finite element analysis: a comparison of an all-polyethylene tibial implant and its metal-backed equivalent. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2560-2566.
38. Malinzak R A, Small S R, Rogge R D, et al. The effect of rotating platform TKA on strain distribution and torque transmission on the proximal tibia. J Arthroplasty, 2014, 29(3): 541-547.
39. Del-Valle-Mojica J, Alonso-Rasgado T, Jimenez-Cruz D, et al. Effect of femoral head size, subject weight, and activity level on acetabular cement mantle stress following total hip arthroplasty. J Orthop Res, 2019, 37(8): 1771-1783.

Journal of Biomedical Engineering

The influence of articular surface conformity on the biomechanics of rotating hinge knee prostheses

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