Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Longfei ¹ , LIN Tianye ^2,3 , HE Mincong ^2,3 , HE Xiaoming ^2,3 , ZHAN Zhiwei ¹ , LU Shun ¹ , ZENG Zijun ¹ , LIN Kun ¹ , TIAN Jiaqing ¹ , HOU Wenyuan ¹ , WEI Tengfei ¹ ,  WEI Qiushi ^2,3,4

1. Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China;
3. Department of Joint Center, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P. R. China;
4. State Key Laboratory of Traditional Chinese Medicine Syndrome/Orthopaedics, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P. R. China;

Corresponding?author：

WEI Qiushi, Email: weiqshi@126.com

Keywords：

Knee osteoarthritis; lower limb force line; low-density area; knee varum; finite element analysis

DOI：

10.7507/1002-1892.202312026

Video：

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Objective To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau. Methods A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results. Results The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences (P<0.05). Conclusion The existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.

Citation： HAN Longfei, LIN Tianye, HE Mincong, HE Xiaoming, ZHAN Zhiwei, LU Shun, ZENG Zijun, LIN Kun, TIAN Jiaqing, HOU Wenyuan, WEI Tengfei, WEI Qiushi. Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 734-741. doi: 10.7507/1002-1892.202312026 Copy

1.	Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet, 2005, 365(9463): 965-973.
2.	Zhang Z, Huang C, Jiang Q, et al. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). Ann Transl Med, 2020, 8(19): 1213. doi: 10.21037/atm-20-4665.
3.	林華, 包麗華. 骨質疏松性骨折的骨損害. 中華醫學雜志, 2022, 102(13): 903-907.
4.	曾國慶, 董鏗, 黃建軍. 膝骨關節炎與骨質疏松癥的相關性分析. 中國衛生標準管理, 2023, 14(18): 94-97.
5.	Hulet C, Sabatier JP, Souquet D, et al. Distribution of bone mineral density at the proximal tibia in knee osteoarthritis. Calcif Tissue Int, 2002, 71(4): 315-322.
6.	Li Y, Liem Y, Dall’Ara E, et al. Subchondral bone microarchitecture and mineral density in human osteoarthritis and osteoporosis: A regional and compartmental analysis. J Orthop Res, 2021, 39(12): 2568-2580.
7.	Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women. Clin Orthop Surg, 2014, 6(4): 420-425.
8.	Geusens PP, van den Bergh JP. Osteoporosis and osteoarthritis: shared mechanisms and epidemiology. Curr Opin Rheumatol, 2016, 28(2): 97-103.
9.	Stamenkovic BN, Rancic NK, Bojanovic MR, et al. Is osteoarthritis always associated with low bone mineral density in elderly patients? Medicina (Kaunas), 2022, 58(9): 1207. doi: 10.3390/medicina58091207.
10.	詹芝瑋, 韋雨柔, 林天燁, 等. 膝骨關節炎內翻畸形與脛骨平臺下低密度影面積的關聯. 中華關節外科雜志 (電子版), 2023, 17(2): 209-215.
11.	Zhang ZH, Qi YS, Wei BG, et al. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol, 2023, 11: 1127289. doi: 10.3389/fbioe.2023.1127289.
12.	黃道強. 腓骨高位截骨治療膝關節內側間室骨性關節炎的有限元分析. 廣州: 南方醫科大學, 2020.
13.	汪小健, 呂帥潔, 李少廣, 等. 全膝關節置換術中下肢機械軸的研究進展. 中國骨傷, 2021, 34(2): 191-194.
14.	Yan M, Liang T, Zhao H, et al. Model properties and clinical application in the finite element analysis of knee joint: A review. Orthop Surg, 2024, 16(2): 289-302.
15.	Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976), 2003, 28(10): 991-996.
16.	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.
17.	李鐘鑫. 膝關節單間室假體置換的生物力學研究. 天津: 天津理工大學, 2021.
18.	劉蒙飛, 馬鵬程, 尹燦, 等. 不同骨密度對膝關節單髁置換后關節內各結構影響的三維有限元分析. 中國組織工程研究, 2024, 28(24): 3801-3806.
19.	Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
20.	楊鵬, 魏秋實, 陳達, 等. 基于頭臼接觸理論構建具有精確軟骨受力面的股骨近端三維模型. 廣東醫學, 2017, 38(20): 3127-3131.
21.	張偉光. 固定平臺單髁膝關節置換在不同脛骨后傾截骨角度下的有限元分析. 大連: 大連醫科大學, 2023.
22.	Taylor WR, Heller MO, Bergmann G, et al. Tibio-femoral loading during human gait and stair climbing. J Orthop Res, 2004, 22(3): 625-632.
23.	馬鵬程, 張思平, 孫榮鑫, 等. 單髁置換股骨假體不同放置位置的生物力學效應. 中國組織工程研究, 2022, 26(12): 1843-1848.
24.	朱廣鐸, 郭萬首, 程立明, 等. 活動平臺單髁膝關節置換脛骨后傾的有限元分析. 中國組織工程研究, 2015, 19(44): 7156-7162.
25.	Abramoff B, Caldera FE. Osteoarthritis: Pathology, diagnosis, and treatment options. Med Clin North Am, 2020, 104(2): 293-311.
26.	Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res, 2018, 11: 2189-2196.
27.	陳德勝, 張晨, 王碩, 等. 膝關節骨性關節炎股骨髁負重區與非負重區組織形態學觀察的研究. 中國當代醫藥, 2023, 30(20): 5-8,封3.
28.	Mills K, Hunt MA, Leigh R, et al. A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking. Clin Biomech (Bristol, Avon), 2013, 28(7): 713-724.
29.	李西海, 許麗梅, 李慧, 等. 不均勻沉降理論與膝骨關節炎筋骨失衡的關系. 中華中醫藥雜志, 2019, 34(4): 1481-1483.
30.	Barnsley J, Buckland G, Chan PE, et al. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res, 2021, 33(4): 759-773.
31.	Hartley A, Gregson CL, Paternoster L, et al. Osteoarthritis: Insights offered by the study of bone mass genetics. Curr Osteoporos Rep, 2021, 19(2): 115-122.
32.	Linde KN, Puhakka KB, Langdahl BL, et al. Bone mineral density is lower in patients with severe knee osteoarthritis and attrition. Calcif Tissue Int, 2017, 101(6): 593-601.
33.	胡楠, 王沛, 張競, 等. 骨質疏松型膝骨關節炎患者骨代謝及生活質量評估. 中國骨質疏松雜志, 2023, 29(6): 832-839.
34.	王紹龍, 李騰飛, 郭宗磊, 等. 絕經后膝骨關節炎患者骨密度與內翻畸形的相關性研究. 醫學研究雜志, 2023, 52(1): 84-88, 92.
35.	Chaudhary M, Walker PS. Analysis of an early intervention distal femoral resurfacing implant for medial osteoarthritis. J Biomech, 2016, 49(15): 3676-3681.
36.	Boyd JL, Zavatsky AB, Gill HS. Does increasing applied load lead to contact changes indicative of knee osteoarthritis? A subject-specific FEA study. Int J Numer Method Biomed Eng, 2016, 32(4): e02740. doi: 10.1002/cnm.2740.
37.	Saeidi M, Ramezani M, Kelly P, et al. Preliminary study on a novel minimally invasive extra-articular implant for unicompartmental knee osteoarthritis. Med Eng Phys, 2019, 67: 96-101.
38.	Yang JC, Lin KY, Lin HH, et al. Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis. PLoS One, 2021, 16(2): e0247412. doi: 10.1371/journal.pone.0247412.
39.	Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
40.	張吉超, 董躍福, 牟志芳, 等. 骨關節炎患者在不同步態角度下膝關節內部生物力學變化的有限元分析. 中國組織工程研究. 2022, 26(9): 1357-1361.

1. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet, 2005, 365(9463): 965-973.
2. Zhang Z, Huang C, Jiang Q, et al. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). Ann Transl Med, 2020, 8(19): 1213. doi: 10.21037/atm-20-4665.
3. 林華, 包麗華. 骨質疏松性骨折的骨損害. 中華醫學雜志, 2022, 102(13): 903-907.
4. 曾國慶, 董鏗, 黃建軍. 膝骨關節炎與骨質疏松癥的相關性分析. 中國衛生標準管理, 2023, 14(18): 94-97.
5. Hulet C, Sabatier JP, Souquet D, et al. Distribution of bone mineral density at the proximal tibia in knee osteoarthritis. Calcif Tissue Int, 2002, 71(4): 315-322.
6. Li Y, Liem Y, Dall’Ara E, et al. Subchondral bone microarchitecture and mineral density in human osteoarthritis and osteoporosis: A regional and compartmental analysis. J Orthop Res, 2021, 39(12): 2568-2580.
7. Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women. Clin Orthop Surg, 2014, 6(4): 420-425.
8. Geusens PP, van den Bergh JP. Osteoporosis and osteoarthritis: shared mechanisms and epidemiology. Curr Opin Rheumatol, 2016, 28(2): 97-103.
9. Stamenkovic BN, Rancic NK, Bojanovic MR, et al. Is osteoarthritis always associated with low bone mineral density in elderly patients? Medicina (Kaunas), 2022, 58(9): 1207. doi: 10.3390/medicina58091207.
10. 詹芝瑋, 韋雨柔, 林天燁, 等. 膝骨關節炎內翻畸形與脛骨平臺下低密度影面積的關聯. 中華關節外科雜志 (電子版), 2023, 17(2): 209-215.
11. Zhang ZH, Qi YS, Wei BG, et al. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol, 2023, 11: 1127289. doi: 10.3389/fbioe.2023.1127289.
12. 黃道強. 腓骨高位截骨治療膝關節內側間室骨性關節炎的有限元分析. 廣州: 南方醫科大學, 2020.
13. 汪小健, 呂帥潔, 李少廣, 等. 全膝關節置換術中下肢機械軸的研究進展. 中國骨傷, 2021, 34(2): 191-194.
14. Yan M, Liang T, Zhao H, et al. Model properties and clinical application in the finite element analysis of knee joint: A review. Orthop Surg, 2024, 16(2): 289-302.
15. Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976), 2003, 28(10): 991-996.
16. 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.
17. 李鐘鑫. 膝關節單間室假體置換的生物力學研究. 天津: 天津理工大學, 2021.
18. 劉蒙飛, 馬鵬程, 尹燦, 等. 不同骨密度對膝關節單髁置換后關節內各結構影響的三維有限元分析. 中國組織工程研究, 2024, 28(24): 3801-3806.
19. Genda E, Iwasaki N, Li G, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech, 2001, 34(7): 895-905.
20. 楊鵬, 魏秋實, 陳達, 等. 基于頭臼接觸理論構建具有精確軟骨受力面的股骨近端三維模型. 廣東醫學, 2017, 38(20): 3127-3131.
21. 張偉光. 固定平臺單髁膝關節置換在不同脛骨后傾截骨角度下的有限元分析. 大連: 大連醫科大學, 2023.
22. Taylor WR, Heller MO, Bergmann G, et al. Tibio-femoral loading during human gait and stair climbing. J Orthop Res, 2004, 22(3): 625-632.
23. 馬鵬程, 張思平, 孫榮鑫, 等. 單髁置換股骨假體不同放置位置的生物力學效應. 中國組織工程研究, 2022, 26(12): 1843-1848.
24. 朱廣鐸, 郭萬首, 程立明, 等. 活動平臺單髁膝關節置換脛骨后傾的有限元分析. 中國組織工程研究, 2015, 19(44): 7156-7162.
25. Abramoff B, Caldera FE. Osteoarthritis: Pathology, diagnosis, and treatment options. Med Clin North Am, 2020, 104(2): 293-311.
26. Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res, 2018, 11: 2189-2196.
27. 陳德勝, 張晨, 王碩, 等. 膝關節骨性關節炎股骨髁負重區與非負重區組織形態學觀察的研究. 中國當代醫藥, 2023, 30(20): 5-8,封3.
28. Mills K, Hunt MA, Leigh R, et al. A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking. Clin Biomech (Bristol, Avon), 2013, 28(7): 713-724.
29. 李西海, 許麗梅, 李慧, 等. 不均勻沉降理論與膝骨關節炎筋骨失衡的關系. 中華中醫藥雜志, 2019, 34(4): 1481-1483.
30. Barnsley J, Buckland G, Chan PE, et al. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res, 2021, 33(4): 759-773.
31. Hartley A, Gregson CL, Paternoster L, et al. Osteoarthritis: Insights offered by the study of bone mass genetics. Curr Osteoporos Rep, 2021, 19(2): 115-122.
32. Linde KN, Puhakka KB, Langdahl BL, et al. Bone mineral density is lower in patients with severe knee osteoarthritis and attrition. Calcif Tissue Int, 2017, 101(6): 593-601.
33. 胡楠, 王沛, 張競, 等. 骨質疏松型膝骨關節炎患者骨代謝及生活質量評估. 中國骨質疏松雜志, 2023, 29(6): 832-839.
34. 王紹龍, 李騰飛, 郭宗磊, 等. 絕經后膝骨關節炎患者骨密度與內翻畸形的相關性研究. 醫學研究雜志, 2023, 52(1): 84-88, 92.
35. Chaudhary M, Walker PS. Analysis of an early intervention distal femoral resurfacing implant for medial osteoarthritis. J Biomech, 2016, 49(15): 3676-3681.
36. Boyd JL, Zavatsky AB, Gill HS. Does increasing applied load lead to contact changes indicative of knee osteoarthritis? A subject-specific FEA study. Int J Numer Method Biomed Eng, 2016, 32(4): e02740. doi: 10.1002/cnm.2740.
37. Saeidi M, Ramezani M, Kelly P, et al. Preliminary study on a novel minimally invasive extra-articular implant for unicompartmental knee osteoarthritis. Med Eng Phys, 2019, 67: 96-101.
38. Yang JC, Lin KY, Lin HH, et al. Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis. PLoS One, 2021, 16(2): e0247412. doi: 10.1371/journal.pone.0247412.
39. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
40. 張吉超, 董躍福, 牟志芳, 等. 骨關節炎患者在不同步態角度下膝關節內部生物力學變化的有限元分析. 中國組織工程研究. 2022, 26(9): 1357-1361.

Chinese Journal of Reparative and Reconstructive Surgery

Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment

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