Titolo: Consequences of Misplacement of different type of Knee Prosthesis

Annachiara Di Stasio, Bernardo Innocenti, Silvia Pianigiani

Abstract
In the Total Knee Arthoplasty (TKA) procedure surgeons use different type of prosthesis due to
different companies products and models. Every type can have problems in the outcome of the
surgery that affect the final results and the perfect recovery of the patients. The different anatomy
of each patients can create complication, not only in case of a pathologys presence but also when
the shape of the bones are different from the ideal one. When the prosthesis is not in the perfect
position there would be much more problems. In fact the misplacements cause a change in the
points of contact between the devices components and so a change in the forces that develop in that
point. In this study it will be analyzed how different designs impact the TKA, using single radius
and multi radius prosthesis made by different companies and what happens when surgeons makes
some mistakes, or more in general the consequences of misplacement of different kind of knee
prosthesis. It will be taken in consideration this different behavior during the gait. Gait activity is
one of the most frequent activity in the daily life and is necessary to guarantee the better
performance possible. It will be also studied the sensitivity of five different placement of the
femoral component in relation with the ideal one.

Materials and methods

It will be used a CAD software, Solidwork to create a model of the different parts of the prosthesis
and then import the part in a Finite Element Analysis - FEA and Simulation Software, Abaqus
where the design will be validated optimizing the geometry of the models and adding the material
of the single component: femoral component, polyethylene insert and the tibial component, in
which we dont take in consideration the stem. And then we will consider the position of collateral
ligaments: lateral and medial.
(I just start to exercise with Solidwork trying to understand basic command and procedural while
waiting for further information on what to do.)

Report
First of all a research in literature was done for understanding the nature of a knee prosthesis and
how it works, the different stages of an implant surgery and the different kind of prosthesis on the
market.
A knee prosthesis is composed of three principal parts:
- a femoral component, that it take place of one or both femoral condyles and in general it is in a
metallic alloy like CoCr (cobalt - chrome)
- a tibial component, with a metallic tibial tray, generally made of titanium, that is positioned on the
proximal part of the tibia
- a tibial insert, in ultra high molecular weight polyethylene (UHMWPE), that is situated on the top
of the tibial tray. It can be fixed or mobile for a better reproduction of physiological movements.
Different types of the implant are due to fixing, in other words if the prosthesis is cemented or not,
constrain and the number of the replaced compartments.
In this study it will analyzed TKA and in particular posterior stabilized (PS) prosthesis, with the
sacrifice of both cruciate ligaments. This type of prosthesis incorporates a central post (camma) in
the polyethylene insert to substitute its control of posterior tibial displacement during flexion,
effectively blocking translation movements.

The main difference between the implants that is considered in this project is in the femoral
components. In fact it can be:

- SINGLE RADIUS where there is only a fixed rotation axis for the flexion
extension and this axis rotates simultaneously with the femur during the
internal external rotation

- MULTI RADIOUS or J-Curve has a multi radius sagittal profile to mimic

the kinematics of the normal knee, which was thought to have a changing
center of rotation with knee flexion.

Many contemporary femoral design attempt to reproduce physiological knee kinematics using
different rotation axes of knee flexion and extension. It seems that J-Curve change the distribution
of condylar radius forces in the femoral components to accommodate this kind of device. Single
radius systems are characterized by a longer extensor moment arm by incorporating a femoral
design with a single radius of knee flexion and extension through a more distal and posterior axis.
According to previous studies, like Daward Abbos and R.S. Gunn (2006) and Frank R. Kolisek and
C. Lowry Barnes (2006), Single Radius prosthesis show better functional long-term outcome and
better performance, if we thinks in terms of survival and post surgery complications like patellafemoral symptoms, anterior knee pain, patellar clunk and backside wear. In fact it appears that there
is a decrease in the patellar load due to an increased extensor moment arm, a decrease in the
required muscular strength for knee extension and a better ligament stability based on a maintained
isometry during the movement (Enrique Gmez-Barrena et al. 2010).
There would be taken in consideration both types of prosthesis in particular for four different
company.

Stryker: Triathlon Knee

Zimmer: NexGen LPS-Flex Knee

Bioimpianti: K-Mod Knee

Corin: Unite Knee

Implant System
Stryker Triathlon Knee
(GetAroundKnee)
Zimmer NexGen LPS-Flex
Knee
Bioimpianti K-Mod Knee
Corin Unity Knee

Single Radius of Curvature

100

Total Range of Motion

104

113

144

*I looking at all the website but I didnt find out anything

Features of each prosthesis:
- Stryker Triathlon Knee
Design features such as a patent pending anatomic radius, deep flexion radius and flared posterior
condyles, as well as Rotary Arc and anatomic patellofemoral track allow the Triathlon Knee System
to maintain substantial contact area throughout the entire range of motion.
The deep flexion features of the components are designed to optimize rotation in deep flexion
without sacrificing stability. The femoral geometry in conjunction with the Rotary Arc
accommodate increasing amounts of internal/external rotation as necessitated by greater degrees of
flexion.
- Zimmer NexGen LPS-Flex Knee
Each system includes a metal femoral component that replaces the end of the thigh bone (femur), a
metal tibial base plate that replaces the top of the shin bone (tibia), and a plastic articular surface
component that is loosely attached to the tibial base plate and serves as artificial cartilage between
the femoral component and the tibial base plate. The femoral component and tibial base plate are
implanted using bone cement. As in most total knee implant systems, the femoral component of a
mobile-bearing knee rides on top of the articular surface component to provide the knee's bending
movement. A mobile-bearing knee design allows the articular surface component to rotate on the
tibial base plate to allow free movement as needed.
- Corin Unity Knee
They have this peculiar features:
Balancing the MCL: Utilising modern knee kinematic principles to help facilitate medial joint line
preservation and collateral ligament stability
Balancing the patella: Incorporating advanced design technologies to help optimise patellofemoral
joint balance.

Balancing the soft tissue envelope: Facilitating the preservation of proprioception and mechanical
function of the knee soft tissue envelope
- Bioimpianti K-Mod Knee
The physiological groove of the femoral component enables optimum patellofemoral kinematics to
reduce the risk of patellar dislocation and improve long-term outcomes. The anterior inclination of
the femoral component aids bone cement (PMMA) compression, thereby facilitating the prosthesis
implant and reducing notching. The tibial component is designed to accommodate tibial stems when
further stabilization is needed, offered in 21 sizes to meet specific patients needs. UNCEMENTED
K-MOD is provided with a Ti-Growth-C titanium plasma spray coating. The bi-metal design
makes it possible to maintain the cobalt-chrome mechanical guarantees and at the same time make
use of the properties of titanium, which stimulates osseointegration thanks to its high porosity. The
bone-cement interface under the tibial tray is provided with a small cavity designed to
accommodate bone cement in order to facilitate the implant of the component. Maximum Stability
of meniscal insert/fixed tibial tray coupling. To further assure stability, the additional fixation screw
is provided with a specially designed system preventing it from unscrewing.
Actually I didnt find much information, because website are patients friendly so they lack of all
specific and technical information, the one I really want to find out. I have only the pamphlets that
are available on the internet. Honestly Im not really sure of what information I really need.

Discussion and Development

In this two first weeks I understand how knee prosthesis work and what are the main problems
surgeons and patients observe before and after an TKA such as patella-femoral symptoms, anterior
knee pain, patellar clunk and backside wear but also instability due to excessive and unnatural
movement of the implant components, problems during flexion after the implant. These problems
depend on the misplacement of the prosthesis as well the interaction between the implants and the
bones. In the meanwhile I get the rope of the use of Solidwork with simple figures and solid.
Next step it will be start working with the model of a prosthesis with Solidwork and understand
what is the better one.

References
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Frank R. Kolisek, C. Lowry Barnes. Scorpio Posterior-Stabilized Knee System: 5-Year Clinical
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Enrique Gmez-Barrena, Carmelo Fernandez-Garca, Almudena Fernandez-Bravo, Raquel
Cutillas-Ruiz, Gloria Bermejo-Fernandez. Functional Performance with a Single-Radius femoral
Design Total Knee Arthroplasty. Clin Orthop Relat Res (2010) 468: 1214-1220
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