Numerical analysis research on the impact of tibial tray fixation peg structure on initial fixation stability in total knee arthroplasty_Journal of Biomedical Engineering

Authors：

LING Yuanxu ¹ , HAN Jianian ¹ , ZHANG Zhifeng ² , PENG Yinghu ³ , ZHANG Jing ¹ ,  CHEN Zhenxian ¹ , JIN Zhongmin ⁴

1. School of Mechanical Engineering, Chang'an University, Xi'an 710064, P. R. China;
2. Department of Joint Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010110, P. R. China;
3. Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518000, P. R. China;
4. Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China;

Corresponding?author：

CHEN Zhenxian, Email: zhenxian_chen@yeah.net

Keywords：

Total knee arthroplasty; Posterior-stabilized knee prosthesis; Tibial tray; Fixation peg design; Von Mises stress; Micromotion

DOI：

10.7507/1001-5515.202506082

Video：

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This study aims to investigate the impact of tibial tray fixation peg structure in posterior stabilized (PS) knee prostheses on its initial fixation stability, a finite element model and a micromotion prediction model of PS total knee arthroplasty (TKA) were established to comparatively study the differences in the von Mises stress of the proximal tibia and the micromotion at the bone-prosthesis fixation interface under four PS tibial tray fixation peg design, namely cylindrical plus hemispherical, cylindrical plus conical, hexagonal prism, and cruciform. The results showed that, at the moment of the maximum force of knee joint during level walking activity, there was no significant difference in the tibial von Mises stress between the tibial tray with or without fixation peg designs. However, the peak micromotions at the prosthesis fixation interface of all tibial trays with fixation peg design were significantly reduced. Among them, the micromotion suppression effect of the cruciform fixation peg was the most obvious. At the moment of the maximum flexion angle of knee joint during squatting activity, the tibial von Mises stress for tibial trays with fixation peg design was clearly lower than that without fixation peg design, meanwhile the peak micromotion at the prosthesis fixation interface was also significantly reduced. Overall, the cruciform fixation peg design showed the best fixation stability and effectively reduced the loosening risk at the prosthesis fixation interface. This study recommended that the backside of the tibial tray in non-cemented PS knee prostheses adopted a design combining a cylindrical stem with a serrated keel and a cruciform fixation peg. This study provided an important reference basis for improving the initial fixation stability of non-cemented PS knee prostheses by optimizing the backside design of the tibial tray.

1.	Sánchez E, Schilling C, Grupp T M, et al. No effect in primary stability after increasing interference fit in cementless TKA tibial components. J Mech Behav Biomed Mater, 2021, 118: 104435.
2.	Fitzpatrick C K, Clary C W, Cyr A J, et al. Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res, 2013, 31(9): 1438-1446.
3.	Watanabe T, Koga H, Horie M, et al. Post-cam design and contact stress on tibial posts in posterior-stabilized total knee prostheses: comparison between a rounded and a squared design. J Arthroplasty, 2017, 32(12): 3757-3762.
4.	Nakayama K, Matsuda S, Miura H, et al. Contact stress at the post-cam mechanism in posterior-stabilised total knee arthroplasty. J Bone Joint Surg Br, 2005, 87(4): 483-488.
5.	Zaffagnini S, Bignozzi S, Saffarini M, et al. Comparison of stability and kinematics of the natural knee versus a PS TKA with a 'third condyle'. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8): 1778-1785.
6.	Movassaghi K, Patel A, Ghulam-Jelani Z, et al. Modern total knee arthroplasty bearing designs and the role of the posterior cruciate ligament. Arthroplast Today, 2023, 21: 101130.
7.	Arnout N, Vanlommel L, Vanlommel J, et al. Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3343-3353.
8.	Meneghini R M, Daluga A, Soliman M. Mechanical stability of cementless tibial components in normal and osteoporotic bone. J Knee Surg, 2011, 24(3): 191-196.
9.	Aujla R S, Esler C N. Total knee arthroplasty for osteoarthritis in patients less than fifty-five years of age: a systematic review. J Arthroplasty, 2017, 32(8): 2598-2603.
10.	Dalury D F. Cementless total knee arthroplasty: current concepts review. Bone Joint J, 2016, 98-B(7): 867-873.
11.	Sharkey P F, Lichstein P M, Shen C, et al. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty, 2014, 29(9): 1774-1778.
12.	Quevedo Gonzalez F J, Lipman J D, Sculco P K, et al. An anterior spike decreases bone-implant micromotion in cementless tibial baseplates for total knee arthroplasty: a biomechanical study. J Arthroplasty, 2024, 39(5): 1323-1327.
13.	Taylor M, Barrett D S, Deffenbaugh D. Influence of loading and activity on the primary stability of cementless tibial trays. J Orthop Res, 2012, 30(9): 1362-1368.
14.	Solarino G, Carlet A, Moretti L, et al. Clinical results in posterior-stabilized total knee arthroplasty with cementless tibial component in porous tantalum: comparison between monoblock and two pegs vs modular and three pegs. Prosthesis, 2022, 4(2): 160-168.
15.	Yang H, Bayoglu R, Clary C W, et al. Impact of patient, surgical, and implant design factors on predicted tray-bone interface micromotions in cementless total knee arthroplasty. J Orthop Res, 2023, 41(1): 115-129.
16.	Morwood M P, Guss A D, Law J I, et al. Metaphyseal stem extension improves tibial stability in cementless total knee arthroplasty. J Arthroplasty, 2020, 35(10): 3031-3037.
17.	Bhimji S, Meneghini R M. Micromotion of cementless tibial baseplates: keels with adjuvant pegs offer more stability than pegs alone. J Arthroplasty, 2014, 29(7): 1503-1506.
18.	Fregly B J, Besier T F, Lloyd D G, et al. Grand challenge competition to predict in vivo knee loads. J Orthop Res, 2012, 30(4): 503-513.
19.	Quevedo González F J, Lipman J D, Lo D, et al. Mechanical performance of cementless total knee replacements: It is not all about the maximum loads. J Orthop Res, 2019, 37(2): 350-357.
20.	Yang H, Behnam Y, Clary C W, et al. Drivers of initial stability in cementless TKA: isolating effects of tibiofemoral conformity and fixation features. J Mech Behav Biomed Mater, 2022, 136: 105507.
21.	Chen Z, Han J, Zhang J, et al. Tibial post loading increases the risk of aseptic loosening of posterior-stabilized tibial prosthesis. Proc Inst Mech Eng H, 2024, 238(8-9): 886-896.
22.	馬張穩, 張兵, 薛敏, 等. UKA 脛骨托盤背部設計對骨-假體固定界面的生物力學影響. 醫用生物力學, 39(4): 637-643.
23.	Ravishanker B B, Raghuvir P B, Satish S B, et al. Effect of polyethylene insert thickness and implant material on micromotions at the bone-implant surface with cemented TKA: a finite element study. Journal of Computational Methods in Science and Engineering, 2021, 21(3): 555-561.
24.	Yang H, Bayoglu R, Clary C W, et al. Impact of surgical alignment, tray material, PCL condition, and patient anatomy on tibial strains after TKA. Med Eng Phys, 2021, 88: 69-77.
25.	Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
26.	Chen Z, Zhang J, Gao Y, et al. Effects of interference assembly of a tibial insert on the tibiofemoral contact mechanics in total knee replacement. Proc Inst Mech Eng H, 2019, 233(9): 948-953.
27.	Abdelgaied A, Liu F, Brockett C, et al. Computational wear prediction of artificial knee joints based on a new wear law and formulation. J Biomech, 2011, 44(6): 1108-1116.
28.	Chong D Y R, Hansen U N, Amis A A. Cementless mis mini-keel prosthesis reduces interface micromotion versus standard stemmed tibial components. Journal of Mechanics in Medicine and Biology, 2016, 16(05): 1650070.
29.	Glenday J D, Wright T M, Lipman J D, et al. Effect of varus alignment on the bone-implant interaction of a cementless tibial baseplate during gait. J Orthop Res, 2022, 40(4): 816-825.
30.	陳瑱賢, 張志峰, 高永昌, 等. 后穩定型全膝關節假體的骨肌多體動力學研究. 生物醫學工程學雜志, 2022, 39(4): 651-659.
31.	Han J, Zhang W, Zhang J, et al. Post-cam design influences the mechanics and interface micromotion of the tibial prosthesis fixation in posterior-stabilized total knee arthroplasty: comparison among three common designs. J Arthroplasty, 2025, 40(11): 3000-3007.

1. Sánchez E, Schilling C, Grupp T M, et al. No effect in primary stability after increasing interference fit in cementless TKA tibial components. J Mech Behav Biomed Mater, 2021, 118: 104435.
2. Fitzpatrick C K, Clary C W, Cyr A J, et al. Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res, 2013, 31(9): 1438-1446.
3. Watanabe T, Koga H, Horie M, et al. Post-cam design and contact stress on tibial posts in posterior-stabilized total knee prostheses: comparison between a rounded and a squared design. J Arthroplasty, 2017, 32(12): 3757-3762.
4. Nakayama K, Matsuda S, Miura H, et al. Contact stress at the post-cam mechanism in posterior-stabilised total knee arthroplasty. J Bone Joint Surg Br, 2005, 87(4): 483-488.
5. Zaffagnini S, Bignozzi S, Saffarini M, et al. Comparison of stability and kinematics of the natural knee versus a PS TKA with a 'third condyle'. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8): 1778-1785.
6. Movassaghi K, Patel A, Ghulam-Jelani Z, et al. Modern total knee arthroplasty bearing designs and the role of the posterior cruciate ligament. Arthroplast Today, 2023, 21: 101130.
7. Arnout N, Vanlommel L, Vanlommel J, et al. Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3343-3353.
8. Meneghini R M, Daluga A, Soliman M. Mechanical stability of cementless tibial components in normal and osteoporotic bone. J Knee Surg, 2011, 24(3): 191-196.
9. Aujla R S, Esler C N. Total knee arthroplasty for osteoarthritis in patients less than fifty-five years of age: a systematic review. J Arthroplasty, 2017, 32(8): 2598-2603.
10. Dalury D F. Cementless total knee arthroplasty: current concepts review. Bone Joint J, 2016, 98-B(7): 867-873.
11. Sharkey P F, Lichstein P M, Shen C, et al. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty, 2014, 29(9): 1774-1778.
12. Quevedo Gonzalez F J, Lipman J D, Sculco P K, et al. An anterior spike decreases bone-implant micromotion in cementless tibial baseplates for total knee arthroplasty: a biomechanical study. J Arthroplasty, 2024, 39(5): 1323-1327.
13. Taylor M, Barrett D S, Deffenbaugh D. Influence of loading and activity on the primary stability of cementless tibial trays. J Orthop Res, 2012, 30(9): 1362-1368.
14. Solarino G, Carlet A, Moretti L, et al. Clinical results in posterior-stabilized total knee arthroplasty with cementless tibial component in porous tantalum: comparison between monoblock and two pegs vs modular and three pegs. Prosthesis, 2022, 4(2): 160-168.
15. Yang H, Bayoglu R, Clary C W, et al. Impact of patient, surgical, and implant design factors on predicted tray-bone interface micromotions in cementless total knee arthroplasty. J Orthop Res, 2023, 41(1): 115-129.
16. Morwood M P, Guss A D, Law J I, et al. Metaphyseal stem extension improves tibial stability in cementless total knee arthroplasty. J Arthroplasty, 2020, 35(10): 3031-3037.
17. Bhimji S, Meneghini R M. Micromotion of cementless tibial baseplates: keels with adjuvant pegs offer more stability than pegs alone. J Arthroplasty, 2014, 29(7): 1503-1506.
18. Fregly B J, Besier T F, Lloyd D G, et al. Grand challenge competition to predict in vivo knee loads. J Orthop Res, 2012, 30(4): 503-513.
19. Quevedo González F J, Lipman J D, Lo D, et al. Mechanical performance of cementless total knee replacements: It is not all about the maximum loads. J Orthop Res, 2019, 37(2): 350-357.
20. Yang H, Behnam Y, Clary C W, et al. Drivers of initial stability in cementless TKA: isolating effects of tibiofemoral conformity and fixation features. J Mech Behav Biomed Mater, 2022, 136: 105507.
21. Chen Z, Han J, Zhang J, et al. Tibial post loading increases the risk of aseptic loosening of posterior-stabilized tibial prosthesis. Proc Inst Mech Eng H, 2024, 238(8-9): 886-896.
22. 馬張穩, 張兵, 薛敏, 等. UKA 脛骨托盤背部設計對骨-假體固定界面的生物力學影響. 醫用生物力學, 39(4): 637-643.
23. Ravishanker B B, Raghuvir P B, Satish S B, et al. Effect of polyethylene insert thickness and implant material on micromotions at the bone-implant surface with cemented TKA: a finite element study. Journal of Computational Methods in Science and Engineering, 2021, 21(3): 555-561.
24. Yang H, Bayoglu R, Clary C W, et al. Impact of surgical alignment, tray material, PCL condition, and patient anatomy on tibial strains after TKA. Med Eng Phys, 2021, 88: 69-77.
25. Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
26. Chen Z, Zhang J, Gao Y, et al. Effects of interference assembly of a tibial insert on the tibiofemoral contact mechanics in total knee replacement. Proc Inst Mech Eng H, 2019, 233(9): 948-953.
27. Abdelgaied A, Liu F, Brockett C, et al. Computational wear prediction of artificial knee joints based on a new wear law and formulation. J Biomech, 2011, 44(6): 1108-1116.
28. Chong D Y R, Hansen U N, Amis A A. Cementless mis mini-keel prosthesis reduces interface micromotion versus standard stemmed tibial components. Journal of Mechanics in Medicine and Biology, 2016, 16(05): 1650070.
29. Glenday J D, Wright T M, Lipman J D, et al. Effect of varus alignment on the bone-implant interaction of a cementless tibial baseplate during gait. J Orthop Res, 2022, 40(4): 816-825.
30. 陳瑱賢, 張志峰, 高永昌, 等. 后穩定型全膝關節假體的骨肌多體動力學研究. 生物醫學工程學雜志, 2022, 39(4): 651-659.
31. Han J, Zhang W, Zhang J, et al. Post-cam design influences the mechanics and interface micromotion of the tibial prosthesis fixation in posterior-stabilized total knee arthroplasty: comparison among three common designs. J Arthroplasty, 2025, 40(11): 3000-3007.

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