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. 2025 Aug 25;42(4):782-789.
doi: 10.7507/1001-5515.202410039.

[Effects of elastic modulus of the metal block on the condylar-constrained knee prosthesis tibial fixation stability]

[Article in Chinese]
Yuhan Zhang  1 , Jing Zhang  1 , Tianqi Dong  1 , Xuan Zhang  1 , Weijie Zhang  2 , Lei Guo  1 , Zhenxian Chen  1
Affiliations

[Effects of elastic modulus of the metal block on the condylar-constrained knee prosthesis tibial fixation stability]

[Article in Chinese]
Yuhan Zhang et al. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. .

Abstract
in English, Chinese

Although metal blocks have been widely used for reconstructing uncontained tibial bone defects, the influence of their elastic modulus on the stability of tibial prosthesis fixation remains unclear. Based on this, a finite element model incorporating constrained condylar knee (CCK) prosthesis, tibia, and metal block was established. Considering the influence of the post-restraint structure of the prosthesis, the effects of variations in the elastic modulus of the block on the von Mises stress distribution in the tibia and the block, as well as on the micromotion at the bone-prosthesis fixation interface, were investigated. Results demonstrated that collision between the insert post and femoral prosthesis during tibial internal rotation increased tibial von Mises stress, significantly influencing the prediction of block elastic modulus variation. A decrease in the elastic modulus of the metal block resulted in increased von Mises stress in the proximal tibia, significantly reduced von Mises stress in the distal tibia, decreased von Mises stress of the block, and increased micromotion at the bone-prosthesis fixation interface. When the elastic modulus of the metal block fell below that of bone cement, inadequate block support substantially increased the risk of stress shielding in the distal tibia and fixation interface loosening. Therefore, this study recommends that biomechanical investigations of CCK prostheses must consider the post-constraint effect, and the elastic modulus of metal blocks for bone reconstruction should not be lower than 3 600 MPa.

虽然金属垫块已被广泛用于重建非包容性胫骨骨缺损，但是其弹性模量对胫骨假体固定稳定性的影响尚不清楚。基于此，本文建立了包含髁限制型膝关节（CCK）假体、胫骨、金属垫块的有限元模型，在考虑假体立柱限制结构影响的情况下，研究了垫块弹性模量变化对胫骨和垫块米塞斯应力、骨—假体固定界面微动的影响。研究表明，胫骨内旋时衬垫立柱与股骨假体发生碰撞会引起胫骨米塞斯应力增大，进而会显著影响垫块弹性模量变化的预测结果；金属垫块弹性模量降低，会导致胫骨近端米塞斯应力增大、胫骨远端米塞斯应力显著降低、垫块米塞斯应力降低、骨—假体固定界面微动增大；当金属垫块弹性模量低于骨水泥时，垫块支撑不足，大大增加了胫骨远端应力屏蔽风险及固定界面松动风险。因此，本文建议CCK假体生物力学研究需考虑立柱限制结构影响，骨重建时金属垫块弹性模量应不低于3 600 MPa。.

Keywords: Constrained condylar knee prosthesis; Finite element analysis; Fixation stability; Metal block.

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Conflict of interest statement

利益冲突声明：本文全体作者均声明不存在利益冲突。

Figures

图 1
图 1
Three dimensional geometric model and finite element model of CCK prosthesis, block, and tibia CCK假体、垫块、胫骨三维几何模型及有限元模型
图 2
图 2
Von Mises stress measurement in different areas of the tibia 胫骨不同区域米塞斯应力测量
图 3
图 3
Influence of the post-restraint structure on the contact pressure of the insert and the von Mises stress of the tibia 立柱限制结构对衬垫接触应力和胫骨米塞斯应力的影响
图 4
图 4
Von Mises stress cloud map of the tibia under blocks with different elastic modulus 不同弹性模量垫块条件下的胫骨米塞斯应力云图
图 5
图 5
Mises stress of the blocks with different elastic modulus 不同弹性模量垫块的米塞斯应力
图 6
图 6
Micromotion distribution at the bone-implant interface under blocks with different elastic modulus 不同弹性模量垫块条件下骨—假体固定界面的微动分布
See this image and copyright information in PMC

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