Impact of Surgical Alignment, Bone Properties, Anterior-Posterior Translation, and Implant Design Factors on Fixation in Cementless Unicompartmental Knee Arthroplasty

Abstract

Micromotion exceeding 150 μm at the implant-bone interface may prevent bone formation and limit fixation after cementless knee arthroplasty. Understanding the critical parameters impacting micromotion is required for optimal implant design and clinical performance. However, few studies have focused on unicompartmental knee arthroplasty (UKA). This study assessed the impacts of alignment, surgical, and design factors on implant-bone micromotions for a novel cementless UKA design during a series of simulated daily activities. Three finite element models that were validated for predicting micromotion of cementless total knee arthroplasty (TKA) were loaded with design-specific kinematics/loading to simulate gait (GT), deep knee bending (DKB), and stair descent (SD). The implant-bone micromotion and the porous surface area ideal for bone ingrowth were estimated and compared to quantify the impact of each factor. Overall, the peak tray-bone micromotions were consistently found at the lateral aspect of the tibial baseplate and were consistently higher than the femoral micromotions. The femoral micromotion was insensitive to almost all the factors studied, and the porous area favorable for bone ingrowth was no less than 93%. For a medial uni, implanting the tray 1 mm medially or the femoral component 1 mm laterally reduced the tibial micromotion by 19.3% and 26.3%, respectively. Differences in tray-bone micromotion due to bone moduli were up to 59.8%. A 5 mm more posterior femoral translation increased the tray-bone micromotion by 35.8%. The presence of the tray keel prevented the spread of the micromotion and increased the overall porous surface area, but also increased peak micromotion. The tray peg and the femoral anterior peg had little impact on the micromotion of their respective implants. In conclusion, centralizing the load transfer to minimize tibial tray applied moment and optimizing the fixation features to minimize micromotion are consistent themes for improving cementless fixation in UKA. Perturbation of femoral-bone alignment may be preferred as it would not create under/overhang on the tibia.

Keywords: cementless; finite element analysis; fixation; micromotion; unicompartmental knee arthroplasty.