DOI: https://doi.org/10.22141/1608-1706.6.18.2017.121187

Biomechanical analysis of conditions of the functioning of knee endoprosthesis in varus deformities in patients with rheumatoid arthritis

I.A. Lazarev, E.M. Avtomeenko, A.M. Babko, M.V. Skiban

Abstract


Background. The defeat of the knee joint (KJ) in rheumatoid arthritis is accompanied by the formation of contractures and the development of discordant deformities of the lower limbs, which in turn lead to a partial or complete loss of limb function. Analysis of the data of domestic and foreign literature suggests that the issue of pathogenesis and mechanogenesis of frontal deformities of knee joints in patients with RA is not paid enough attention, conditions for the functioning of the endoprosthesis of the KJ in the presence of valgus and varus deformities of the limb in rheumatoid arthritis patients have been poorly studied. The purpose was to examine the possibilities of functioning of the endoprosthesis of the KJ with compensation of defects of the tibial condyles with the help of bone grafts or metallic augments at different values of varus deformity in patients with rheumatoid arthritis, as well as to study the work of “bone — endoprosthesis” biomechanical model when compensating the defect of the medial condyle of tibia with bone graft or metal augmentation of 5, 10 and 15 mm, and based on the obtained data to determine the risk of the early instability of the tibial component of the endoprosthesis. Materials and methods. Imitation computer models of the knee were created on the basis of CT scans, which consisted of elements with different mechanical properties — the femur, the femoral component of the endoprosthesis, the polyethylene insert, the tibial component of the endoprosthesis and the tibia. Using SolidWorks software package, simulation models of the knee have been created in the conditions of its varus deformity with the presence of a bone graft and 5-, 10- and 15-mm metal (augment). Further calculations of the model’s stress and strain were carried out by the finite element method (FEM) in the software package ANSYS (a numerical method). Results. The presence of 5-mm bone graft and an increase in its size to 15 mm resulted in a significant increase in the stresses on the tibial plateau by 51 % at 5 mm and almost 2.3 times — at 10 and 15 mm. These values of stress exceed the strength of spongy bone tissue in this area, which may be accompanied by its destruction even at a static load of body weight only when using 10- and 15-mm bone graft. The use of a metal augment of 5 mm and an increase in its size to 10 and 15 mm resulted in the unloading of this site, which was shown by a decrease in stresses by 21 % — at 5 mm, by 8 and by 5 % at 10 and 15 mm, respectively. Conclusions. Application of 10- and 15-mm bone graft is a factor of possible destruction of bone tissue in the area of the tibial component of the endoprosthesis with the development of its instability. Unloading this site when replacing large defects (10 and 15 mm) is achieved using a metal augment.


Keywords


rheumatoid arthritis; knee joint; varus deformity; finite elements modeling; stress-strain state

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