Journal of Biomedical Engineering Research (대한의용생체공학회:의공학회지)

The Korean Society of Medical and Biological Engineering (대한의용생체공학회)
권호 표지
DOI QR코드

DOI QR Code

The Stress Concentration Caused by Pin-hole in Femur after Computer-navigated Total Knee Arthroplasty: A Finite Element Analysis

컴퓨터 네비게이션을 이용한 슬관절 전치환술에서 핀 홀에 의한 응력 집중: 유한요소해석

  • 박형균 (경희대학교 테크노공학대학) ;
  • 김윤혁 (경희대학교 테크노공학대학) ;
  • 박원만 (경희대학교 테크노공학대학) ;
  • 김경수 (경기대학교 수학과)
  • Published : 2008.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Total knee arthroplasty(TKA) using computer-assisted navigation has been increased in order to improve the accuracy of femoral and tibial components implantation. Recently, a few clinical studies have reported on the femoral stress fracture after TKA using computer-assisted navigation. The purpose of this study is to investigate the stress concentration around the femoral pin-hole for different pin-hole diameter, the modes of pin penetration by finite element analysis to understand the effects of pin-hole parameters on femoral stress fracture risk. A three-dimensional finite element model of a male femur was reconstructed from 1 mm thick computed tomography(CT) images. The bone was rigidly fixed to a 25 mm above the distal end and 1500 N of axial compressive force and 12 Nm of axial torsion were applied at the femoral head. For all cases, transcortical pin penetration mode showed the highest stress fracture risk and unicortical pin penetration mode showed the lowest stress concentration. Pin-hole diameter increased the stress concentration, but pin number did not increase the stress dramatically. The results of this study provided a biomechanical guideline for pin-hole fracture risk of the computer navigated TKA.

Keywords

References

  1. H. Bathis, L. Perlick, M. Tingart, C. Luring, D. Zurakowski, and J. Grifka, " Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique," J. Bone Joint Surg. Br., vol. 86, no. 5, pp.682-687, 2004 https://doi.org/10.1302/0301-620X.86B5.14927
  2. B. Stockl, M. Nogler, R. Rosiek, M. Fischer, M. Krismer, and O. Kessler, "Navigation improves accuracy of rotational alignment in total knee arthroplasty," Clin. Orthop. Relat. Res., vol. 426, pp.180-186, 2004 https://doi.org/10.1097/01.blo.0000136835.40566.d9
  3. S.D. Stulberg, P. Loan, and V. Sarin, "Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients," J. Bone Joint Surg. Am., vol. 84, no. 2, pp. 90-98, 2002 https://doi.org/10.2106/00004623-200200002-00011
  4. K.C. Anderson, K.C. Buehler, and D.C. Markel, "Computer assisted navigation in total knee arthroplasty: Comparison with conventional methods," J. Arthroplasty, vol. 20, no. 7, pp.132 -138, 2005
  5. M. Sparmann, B. Wolke, H. Czupalla, D. Banzer, and A. Zink, "Positioning of total knee arthroplasty with and without navigation support: a prospective, ransomised study," J. Bone Joint Surg. Br., vol. 85, no. 6, pp.830-835, 2003
  6. R.G. Haaker, M. Stockheim, M. Kamp, G. Proff, J. Breitenfelder, and A. Ottersbach, "Computer-assisted navigation increases precision of component placement in total knee arthroplasty," Clin. Orthop. Relat. Res., vol. 433, pp.152-159, 2005
  7. J. Victor, and D. Hoste, "Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment," Clin. Orthop. Relat. Res., vol. 428, pp.131-139, 2004 https://doi.org/10.1097/01.blo.0000147710.69612.76
  8. C. Ossendorf, B. Fuchs, and P. Koch, "Femoral stress fracture after computer navigated total knee arthroplasty," Knee, vol. 13, no. 5, pp.397-399, 2006 https://doi.org/10.1016/j.knee.2006.06.002
  9. P. Bonutti, D. Dethmers, and J.B. Stiehl, "Femoral shaft fracture resulting from femoral tracker placement in navigated TKA," Clin. Orthop. Relat. Res., vol. 466, pp.1499-1502, 2008 https://doi.org/10.1007/s11999-008-0150-6
  10. H.J. Jung, Y.B. Jung, K.S. Song, S.J. Park, and J.S. Lee, "Fractures associated with computer-navigated total knee arthroplasty," J.Bone Joint Surg. Am., vol. 89, no. 10, pp.2280-2284, 2007 https://doi.org/10.2106/JBJS.F.01166
  11. J.H. Keyak, S.A. Rossi, K.A. Jones, and H.B. Skinner, "Prediction of femoral fracture load using automated finite element modeling," J. Biomech., vol. 31, no. 2, pp.125-133, 1998
  12. M. Viceconti, L. Bellingeri, L. Cristofolini, and A. Toni, "A comparitive study on different methods of automatic mesh generation on human femurs," Med. Eng. Phys., vol. 20, no. 1, pp.110, 1998
  13. J.H. Heegaard, P.F. Leyvraz, and C.B. Hovey, "A computer model to simulate patellar biomechanics following total knee replacement: the effects of femoral component alignment," Clin. Biomech., vol. 16, no. 5, pp.415-423, 2001 https://doi.org/10.1016/S0268-0033(01)00020-1
  14. R.W. Hsu, S. Himeno, M.B. Coventry, and E.Y. Chao, "Normalaxial alignment of the lower extremity and load-bearing distribution at the knee," Clin. Orthop. Relat. Res., vol. 255, pp.215-227, 1990
  15. T.D. Cooke, E.A. Sled, and R.A. Scudamore, "Frontal plane knee alignment: a call for standardized measurement," J. Rheumatol., vol. 34, no. 9, pp.1796-1801, 2007
  16. M. Papini, R. Zdero, E.H. Schemitsch, and P. Zalzal, "The biomechanics of human femurs in axial and torsional loading: comparison of finite element analysis, human cadaveric femurs, and synthetic femurs," J. Biomech. Eng., vol. 129, no. 1, pp.112- 119, 2007
  17. L. Cristofolini, M. Viceconti, A. Cappello, and A. Toni, "Mechanical validation of whole bone composite femur models," J. Biomech., vol. 29, no. 4, pp.525-535, 1996 https://doi.org/10.1016/0021-9290(95)00084-4
  18. C.J. Wang, A.L. Yettram, M.S. Yao, and P. Procter, "Finite element analysis of a Gamma nail within a fractured femur," Med. Eng. Phys., vol. 20, no. 9, pp.677-683, 1998 https://doi.org/10.1016/S1350-4533(98)00079-4
  19. D.B. Brooks, A.H. Burstein, and V.H. Frankel, "The biomechanics of torsional fractures. The stress concentration effect of a drill hole," J. Bone Joint Surg. Am., vol. 52, no. 3, pp.507-514, 1970 https://doi.org/10.2106/00004623-197052030-00008
  20. S.A. Brumby, R. Carrington, S. Zayontz, T. Reish, and R.D. Scott, "Tibial plateau stress fracture: a complication of unicompartmental knee arthroplasty using 4 guide pinholes," J. Arthroplasty., vol. 18, no. 6, pp.809-812, 2003 https://doi.org/10.1016/S0883-5403(03)00330-9
  21. D.T. Reilly, and A.H. Burstein, "The elastic and ultimate properties of compact bone tissue," J. Biomech, vol. 8, no. 6, pp.393 -405, 1975 https://doi.org/10.1016/0021-9290(75)90075-5