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. 2020 Oct 15:2020:3718705.
doi: 10.1155/2020/3718705. eCollection 2020.

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty

Chong Zheng  1 , Hai-Yang Ma  2 , Yin-Qiao Du  2 , Jing-Yang Sun  2 , Ji-Wei Luo  1 , Dong-Bin Qu  1 , Yong-Gang Zhou  2
Affiliations

Finite Element Assessment of the Screw and Cement Technique in Total Knee Arthroplasty

Chong Zheng et al. Biomed Res Int. .

Abstract

Background: The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles.

Method: Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with cement were generated. Contact stresses on the surface of cancellous bone in different areas were calculated.

Results: Compared to the cement-only technique, the stress on the border of cancellous bone and bone cement decreased by 10% using the screw and cement technique. For bone defects with a 12% defect area and a 12-mm defect depth, the use of 1 screw achieved the greatest stability; for those with a 15% defect area and a 20-mm defect depth, 2 screws achieved the greatest stability.

Conclusions: (1) The screw and cement technique is superior to the bone cement-only technique. For tibial defects in which the defect area comprises a large percentage but the depth is less than 5 mm, the screw and cement technique is recommended. (2) Vertical screws can achieve better stability than oblique screws. (3) Screws should be used in moderation for different defects; more is not always better.

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Conflict of interest statement

All of the authors of this article claim no conflicts of interest.

Figures

Figure 1
Figure 1
(a) TKA meshed block model with a 20% defect area built with three screws and cement. (b) TKA meshed block model with a 20% defect area built with three screws and cement (cement removed).
Figure 2
Figure 2
Pressure load application areas.
Figure 3
Figure 3
Dark blue: three anterior spots (A). Light blue: three posterior spots (P). Yellow: three lateral spots (L). Red: three medial spots (M).
Figure 4
Figure 4
Trisection point of the midcourt line of the medial and lateral tibial plateau.
Figure 5
Figure 5
Stresses (MPa) at 12 spots on the surface of cancellous bone in the medullary cavity.
Figure 6
Figure 6
Stresses (MPa) at 4 trisection points on the medial and lateral plateau. AM: anteriomedial; PM: posteromedial; AL: anterolateral; PL: posteromedial; OB: oblique.
Figure 7
Figure 7
Stresses on the surface of defects (MPa). (a) Six anterior spots on the surface of defects. (b) Six posterior spots on the surface of defects. (c) Six medial spots on the surface of defects. (d) Six lateral spots on the surface of defects.
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