Effect of prosthetic joint line installation height errors on insert wear in unicompartmental knee arthroplasty / 生物医学工程学杂志

The clinical performance and failure issues are significantly influenced by prosthetic malposition in unicompartmental knee arthroplasty (UKA). Uncertainty exists about the impact of the prosthetic joint line height in UKA on tibial insert wear. In this study, we combined the UKA musculoskeletal multibody dynamics model, finite element model and wear model to investigate the effects of seven joint line height cases of fixed UKA implant on postoperative insert contact mechanics, cumulative sliding distance, linear wear depth and volumetric wear. As the elevation of the joint line height in UKA, the medial contact force and the joint anterior-posterior translation during swing phase were increased, and further the maximum von Mises stress, contact stress, linear wear depth, cumulative sliding distance, and the volumetric wear also were increased. Furthermore, the wear area of the insert gradually shifted from the middle region to the rear. Compared to 0 mm joint line height, the maximum linear wear depth and volumetric wear were decreased by 7.9% and 6.8% at -2 mm joint line height, and by 23.7% and 20.6% at -6 mm joint line height, the maximum linear wear depth and volumetric wear increased by 10.7% and 5.9% at +2 mm joint line height, and by 24.1% and 35.7% at +6 mm joint line height, respectively. UKA prosthetic joint line installation errors can significantly affect the wear life of the polyethylene inserted articular surfaces. Therefore, it is conservatively recommended that clinicians limit intraoperative UKA joint line height errors to -2-+2 mm.

Wear prediction for metal-on-metal hip joint replacements / 医用生物力学

Objective To develop a wear prediction model for hard-on-hard hip joint replacement under the condition of complex dynamic loading and time-dependent motion, and to apply it to the study on wear prediction of the typical metal-on-metal hip joint replacement in the complicated three-dimensional (3D) physiological motion condition. Methods The finite element model for contact mechanics was established and the fixed-tracked method was adopted to make the dynamic wear reappear on the bearing surface of artificial hip joint with 3D Euler transformation, and the data communication about the corresponding contact and wear for simulation was also made. Results The wear prediction test showed that the spherical bearing geometry of the artificial hip joint gradually became the non-spherical form due to the wear with time; meanwhile, the corresponding contact area was increased, the distribution of the contact pressure tended to be flattened, and the maximum contact pressure was decreased. Conclusions The wear prediction model developed here for metal-on-metal hip joint replacements with bilateral bearing surfaces under the condition of complex dynamic loading and motion could be used to carry out simulation test for the wear prediction of metal-on-metal artificial joint, which provides a new method to understand the wear mechanism of hip joint replacement.