Download PDF
J Knee Surg 2011; 24(2): 109-116
DOI: 10.1055/s-0031-1280873
ORIGINAL ARTICLE

© Thieme Medical Publishers

Comparison of Interface Stresses and Strains for Onlay and Inlay Unicompartmental Tibial Components

Peter S. Walker1 , 3 , Dhiraj S. Parakh1 , Miriam E. Chaudhary1 , 4 , Chih-Shing Wei2
  • 1Laboratory for Minimally – Invasive Surgery, NYU Hospital for Joint Diseases, New York, New York
  • 2The Cooper Union for the Advancement of Science and Art, New York, New York
  • 3Department of Mechanical and Aerospace Engineering, NYU-Poly, Brooklyn, New York
  • 4Department of Chemical and Biological Sciences, NYU-Poly, Brooklyn, New York
Further Information

Publication History

Publication Date:
08 June 2011 (online)

    Permissions and Reprints

ABSTRACT

There are several types of designs used for unicompartmental tibial components. The all-plastic inlay component is recessed and it preserves bone around the outer edge of the tibia. For an onlay component, the entire condyle is resected, and the plastic bearing is usually metal-backed, although all-plastic components are also available. The purpose of this study was to investigate the hypothesis that while 6-mm inlay components require less bone removal, the peak stresses and strains at the surface of the bone will be much greater when compared with 8-mm metal-backed onlay components, and that all-plastic onlays will be only a slight advantage over inlays. Tibial models were generated using computed tomography (CT) scans, while typical inlay and onlay components were modeled. Finite element analyses of bones and components were completed by assigning material properties based on the CT scans and applying loads. Results indicated that plastic inlays generated 6 times more peak stress at the tibial surface when compared with metal-backed onlays. Moreover, models using inlay components produced strain values exceeding onlay components by a factor of 13.5 due to areas of softer bone at the interface. Off-center loading toward the anterior or posterior of the components produced similar results. The stresses and strains for the 8-mm all-plastic onlay were reduced compared with the inlay but still much higher than for the metal-backed onlay. These findings indicated that metal-backed onlays may be a better option when considering load distribution on the tibial surface.

KEYWORDS

Unicompartmental - stress - strain - onlay - inlay

REFERENCES

  • 1 Price A J, Rees J L, Beard D J, Gill R H, Dodd C A, Murray D M. Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years: a comparative in vivo fluoroscopic analysis.  J Arthroplasty. 2004;  19 (5) 590-597
    CrossrefPubMedGoogle Scholar
  • 2 O'Rourke M R, Gardner J J, Callaghan J J et al.. The John Insall Award: unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study.  Clin Orthop Relat Res. 2005;  440 27-37
    CrossrefPubMedGoogle Scholar
  • 3 Argenson J N, Chevrol-Benkeddache Y, Aubaniac J M. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study.  J Bone Joint Surg Am. 2002;  84-A (12) 2235-2239
    PubMedGoogle Scholar
  • 4 Barrett W P, Scott R D. Revision of failed unicondylar unicompartmental knee arthroplasty.  J Bone Joint Surg Am. 1987;  69 (9) 1328-1335
    PubMedGoogle Scholar
  • 5 Saragaglia D, Estour G, Nemer C, Colle P E. Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results.  Int Orthop. 2009;  33 (4) 969-974
    CrossrefPubMedGoogle Scholar
  • 6 Bartley R E, Stulberg S D, Robb III W J, Sweeney H J. Polyethylene wear in unicompartmental knee arthroplasty.  Clin Orthop Relat Res. 1994;  299 (299) 18-24
    PubMedGoogle Scholar
  • 7 Walker P S, Ranawat C, Insall J. Fixation of the tibial components of condylar replacement knee prostheses.  J Biomech. 1976;  9 (4) 269-275
    CrossrefPubMedGoogle Scholar
  • 8 Cartier P, Sanouiller J-L, Grelsamer R P. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period.  J Arthroplasty. 1996;  11 (7) 782-788
    CrossrefPubMedGoogle Scholar
  • 9 Hvid I. Trabecular bone strength at the knee.  Clin Orthop Relat Res. 1988;  227 210-221
    PubMedGoogle Scholar
  • 10 Goldstein S A, Wilson D L, Sonstegard D A, Matthews L S. The mechanical properties of human tibial trabecular bone as a function of metaphyseal location.  J Biomech. 1983;  16 (12) 965-969
    CrossrefPubMedGoogle Scholar
  • 11 Romanowski M, Repicci J. Minimally invasive unicondylar arthroplasty using a freehand inlay technique.  Tech Knee Surg. 2004;  3 (1) 46-54
    CrossrefPubMedGoogle Scholar
  • 12 Miegel R E, Walker P S, Nelson P C, Inadomi J, Needelman L, Maxine M. A compliant interface for total knee arthroplasty.  J Orthop Res. 1986;  4 (4) 486-493
    CrossrefPubMedGoogle Scholar
  • 13 Shanbhag A S, Hasselman C T, Rubash H E. Technique for generating submicrometer ultra high molecular weight polyethylene particles.  J Orthop Res. 1996;  14 (6) 1000-1004
    CrossrefPubMedGoogle Scholar
  • 14 Huang C H, Liau J J, Huang C H, Cheng C K. Stress analysis of the anterior tibial post in posterior stabilized knee prostheses.  J Orthop Res. 2007;  25 (4) 442-449
    CrossrefPubMedGoogle Scholar
  • 15 Tandon R. Net Shaping of Co-Cr-Mo (F-75) via Metal Injection Molding: Cobalt-Base alloys for Biomedical applications.  ASTM International. 1999;  3-7
    PubMedGoogle Scholar
  • 16 Rapperport D J, Carter D R, Schurman D J. Contact finite element stress analysis of porous ingrowth acetabular cup implantation, ingrowth, and loosening.  J Orthop Res. 1987;  5 (4) 548-561
    CrossrefPubMedGoogle Scholar
  • 17 Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints.  Acta Orthop Scand. 1980;  51 (6) 871-879
    CrossrefPubMedGoogle Scholar
  • 18 Blunn G W, Joshi A B, Lilley P A et al.. Polyethylene wear in unicondylar knee prostheses. 106 retrieved Marmor, PCA, and St Georg tibial components compared.  Acta Orthop Scand. 1992;  63 (3) 247-255
    PubMedGoogle Scholar
  • 19 Heinlein B, Kutzner I, Graichen F et al.. ESB Clinical Biomechanics Award 2008: Complete data of total knee replacement loading for level walking and stair climbing measured in vivo with a follow-up of 6-10 months.  Clin Biomech (Bristol, Avon). 2009;  24 (4) 315-326
    CrossrefPubMedGoogle Scholar
  • 20 Mündermann A, Dyrby C O, D'Lima D D, Colwell Jr C W, Andriacchi T P. In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement.  J Orthop Res. 2008;  26 (9) 1167-1172
    CrossrefPubMedGoogle Scholar
  • 21 D'Lima D D, Patil S, Steklov N, Slamin J E, Colwell Jr C W. The Chitranjan Ranawat Award: in vivo knee forces after total knee arthroplasty.  Clin Orthop Relat Res. 2005;  440 45-49
    CrossrefPubMedGoogle Scholar
  • 22 Thompson M T, Conditt M A, Otto J K et al.. The importance of good cement mantle with an all-poly inlay UKA.  56th Annual Ortho Res Society. 2010;  poster 2121
    PubMedGoogle Scholar
  • 23 Bauze A J, Costi J J, Stavrou P et al.. Cement penetration and stiffness of the cement-bone composite in the proximal tibia in a porcine model.  J Orthop Surg (Hong Kong). 2004;  12 (2) 194-198
    PubMedGoogle Scholar
  • 24 Hvid I, Bentzen S M, Jorgensen J. Remodelling of the tibial plateau after knee replacement.  Acta Orthop Scand. 1988;  59 (5) 567-573
    PubMedGoogle Scholar
  • 25 Bartel D L, Bicknell V L, Wright T M. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement.  J Bone Joint Surg Am. 1986;  68 (7) 1041-1051
    CrossrefPubMedGoogle Scholar
  • 26 Arastu M H, Vijayaraghavan J, Chissell H, Hull J B, Newman J H, Robinson J R. Early failure of a mobile-bearing unicompartmental knee replacement.  Knee Surg Sports Traumatol Arthrosc. 2009;  17 (10) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 27 Lisowski L, Bloemsaat-Minekus J, Curfs I, Lisowski A. Pain in the assessment of oxford phase 3 unicompartmental knee arthroplasty (UKA).  J Bone Joint Surg Br. 2010;  92-B 323
    PubMedGoogle Scholar
  • 28 Simpson D J, Price A J, Gulati A, Murray D W, Gill H S. Elevated proximal tibial strains following unicompartmental knee replacement—a possible cause of pain.  Med Eng Phys. 2009;  31 (7) 752-757
    CrossrefPubMedGoogle Scholar
  • 29 Vince K G, Cyran L T. Unicompartmental knee arthroplasty: new indications, more complications?.  J Arthroplasty. 2004;  19 (4, Suppl 1) 9-16
    CrossrefPubMedGoogle Scholar
  • 30 Springer B D, Scott R D, Thornhill T S. Conversion of failed unicompartmental knee arthroplasty to TKA.  Clin Orthop Relat Res. 2006;  446 214-220
    CrossrefPubMedGoogle Scholar

Peter S. Walker

NYU School of Medicine, VA Medical Center

423 East 23rd Street, Annex Building 2, Room 206A, New York, NY 10010

Email: ptrswlkr@aol.com

      >