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Article

Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study

1
Department of Biomechanical Engineering, University of Twente, 7500 AE Enschede, The Netherlands
2
Orthopedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editor: Carlo Albino Frigo
Appl. Sci. 2021, 11(5), 2423; https://doi.org/10.3390/app11052423
Received: 4 February 2021 / Revised: 3 March 2021 / Accepted: 4 March 2021 / Published: 9 March 2021
(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)
The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints. View Full-Text
Keywords: musculoskeletal model; polyethylene thickness; total knee arthroplasty; ligament forces; compressive forces; patellar kinematics musculoskeletal model; polyethylene thickness; total knee arthroplasty; ligament forces; compressive forces; patellar kinematics
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MDPI and ACS Style

Tzanetis, P.; Marra, M.A.; Fluit, R.; Koopman, B.; Verdonschot, N. Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study. Appl. Sci. 2021, 11, 2423. https://doi.org/10.3390/app11052423

AMA Style

Tzanetis P, Marra MA, Fluit R, Koopman B, Verdonschot N. Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study. Applied Sciences. 2021; 11(5):2423. https://doi.org/10.3390/app11052423

Chicago/Turabian Style

Tzanetis, Periklis, Marco A. Marra, René Fluit, Bart Koopman, and Nico Verdonschot. 2021. "Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study" Applied Sciences 11, no. 5: 2423. https://doi.org/10.3390/app11052423

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