The effect of malalignment of component parts on wear in total knee replacement prothesis
Dissertation task
Please complete the dissertation by adding 8250 words to the proposal as shown in my comments. Please use the references attached and if you have any relevant references, do use them. The total number of references should be 35 refernces.
Please send me a draft of the FEA analysis on 10/01. The analysis should be done with Abaqus 2022. You don’t need to design the knee on the CAD as I have already attached the CAD file for the Knee which can be opened with ABAQUS to perform the Total Knee Replacement FEA analysis.
Submit the whole FEA analysis on 10/02
Submit the whole dissertation on 10/03
Please create a summary of 900 words (bullets point only to be used in ppt slides)
And submit on 20/03
Abstract
Contents
Introduction 3
Aim 5
Objectives 6
Research Method 6
Plan for the progression of the project 7
Health and Safety and Ethics statements 8
References 8
Introduction
A human body knee is a complex joint that is subject to tear and wear and might cause damage due to heavy weight, accidents, ageing or due to diseases or bad nutrition (Zinovy Meyler. 2018).
A damaged knee causes severe pain, swelling and difficulty walking or bending. These symptoms are due to the degenerative damage of the end stage of osteoarthritis to the articular cartilage that is responsible to keep the joint surface protected through lubrication (Illina et al, 2021). Furthermore, degenerative arthritis impacts the knee’s joint at its line cartilage (Shashishekar & Ramesh, 2007) as shown in the anatomy image of a knee joint Figure (1). According to Figure (1), the knee consists of two joints with the first one binds the patella and the femur whilst the second one binds the tibia with the femur (Chandran, et. al, 2021).
Figure 1: Shows the anatomy of the knee joint (Chandran, et. al, 2021)
A total knee replacement (TKR) will be necessitated in order to help the patients with knee problems to move and walk without any pain. The TKR requires medical surgeries by a specialist in orthopaedics; therefore, it becomes imperative to understand how the components of the knee are replaced.
A TKR will include replacing both patella femoral joint and tibia femoral joint as depicted in Figure (2). Moreover, there are different surgiucal methods used for treatment modalities such as high tibial osteotomy (HTO), unicondyler knee arthroplasty (UKA) and the TKR (DEMİRKIRAN, and Husemoglu, 2020). A knee replacement could subject to medical issues due to the loos of some knee components which require a revised surgry as indicated in (Yueh et al, 2021). One of the challenges faced whilst performing TKR is how to maintain the alignment of the artificial joints so that it wants produce pushing to the tibial nerve or the muscles around the knee.
Figure 2: Shows TKR includes the two joints (Loi, et. al, 2021 )
In (Pitta, et al, 2018) a study was conducted to evaluate the main reasons for getting TKR failure. The different failure shows that instability is the main reason with 24% causing 97 failures within 27 months as depicted in Table (1). Other reasons for TKR failures are shown in the same Table (1) developed by the same author.
There is possibility to identify and predict the damage to TKR might occur over the time. The depth of the damages result from the tear and wear can be analysed using a suitable computational software tool as discussed by (Fregly et al, 2005). The maximum damage has been identified through the walk and steps which were separately simulated. This method assists clinically the TKR after the surgery.
The malalignment causes pain and infection if it is not treated promptly. It limits the normal functionality of the TKR such as walking and bending. According to Figure (3), if any of the TKR components are not aligned with the mechanical axis of the joint knee, a TKR malalignment occurs. However, the mechanical axis depicted in Figure (3) is used to show how is the whole human body balanced.
A TKR malalignment occurs for two components namely, the femoral component where the femur bone sits on the bottom and the tibial insert. However, the tibial tray shown in Figure (2) is unlikely to be malaligned due to the total body weight applied to the tibia by the femor. In addition, TKR malalignment should be investigated efficiently in order to reach medical resolution that avoids a revised surgery to rectify one of the parts belongs to the TKR components.
Table 1: Mechanisms of Failure After Total Knee Arthroplasty (Pitta, et al, 2018)
Figure 3: Shows the mechanical axis of the joints of the lower limb, (a) is the front view and (b) is the side view (Shi,2007)
Aim
This project aims to investigate the impact of malalignment due to the tibial bearing surface component of the TKR.
Objectives
Study the existing research about successful TKR by conducting a literature survey.
Explore what parameters impact the functionality of the TKR.
Evaluate the performance of TKR components using the Abaqus software tool.
Perform FEA on the tibial bearing of the TKR.
Investigate how malalignment of the tibial bearing impacts the whole performance during the gait cycle.
Literature review
Research Method
This research can be accomplished by following different approaches based on the software tool used to perform the FEA analysis. The Simulia Abaqus software is recommended to be used (Smith & Nephew, 2011). A normal knee is able to move up to 135°, therefore, should a TKR is deployed, the life span should last very long. This means that the TKR should have a minor tolerance to malalignment. Nevertheless, a malalignment of a TKR could be also due to the material used in the manufacturing such as polyethene (Kumbhalkar, et al, 2013).
For a malalignment, the stress of any kind of prostheses such as for high conformity like flat-on-flat or curve-on-curve, and for medium conformity like flat-on-flat, should be investigated. Therefore, it is imperative to test the contact stress and von Mises stresses that transpired during the high conformity. This test will assume for example a severe malalignment condition as indicated in (Shi, 2007). Therefore, it requires testing all three parts of the TKR. Nevertheless, the following procedure could be followed to perform the analysis:
Pick a TKR CAD model with all associated parts as depicted in Figure (2).
Apply FEA analysis to the Femoral component.
Repeat the FEA analysis to the tibia component assuming a deformity which involves oblique displacement of part of a limb away from the mechanical axis.
A vertical force of 1500N will be applied to the femoral whilst the tibial will be tilted by 4°. This will create a malalignment at the latter angle due to the medial lateral load distribution that changes the even load distribution. This change can be simulated using the Abaqus software.
The analysis will be performed based on the FEA results. Some conclusions and recommendations will be made to reduce the probability of having TKR malalignment and to avoid a revise surgeries.
Plan for the progression of the project
Health and Safety and Ethics statements
It is vital to complete the health and safety before conducting a project which could produce a hazard. Furthermore, the ethics statement will be used to get consent from the participant in the survey. This consent will be shown at the top of the questionnaire and it will not show any personal details like the name or the address. Each participant will be treated anonymously. However, this research is designed to perform desktop analysis using Abaqus software tools. A software version will be installed on a personal computer using the university VPN and approval will be sought beforehand regarding the license. They will be no health and safety requirements necessary to perform such research and an ethical statement has been sought regarding the use of the Abaqus university standard edition.
Results and analysis
Discussion
Conclusion
References
Zinovy Meyler. 2018. Knee Anatomy. [online], accessed: 22/10/2022. available at: https://www.arthritis-health.com/types/joint-anatomy/knee-anatomy
Illina, Loi, Stanev, Dimitar & Moustakas, Konstantinos. (2021). Total Knee Replacement: Subject-Specific Modeling, Finite Element Analysis, and Evaluation of Dynamic Activities. Frontiers in Bioengineering and Biotechnology. 9. 10.3389/fbioe.2021.648356.
B. J. Fregly, W. G. Sawyera, M. K. Harmand and S. A. Banks. 2005. Computational wear prediction of a total knee replacement from in vivo kinematics. Elsevier publer, Journal of Biomechanics 38 (2005) 305–314.
C. Shashishekar & C. S. Ramesh. 2007. Finite element analysis of prosthetic knee joint using ANSYS. WIT Transactions on Biomedicine and Health, Vol 12, 2007. WIT Press www.witpress.com, ISSN 1743-3525 (on-line) Modelling in Medicine and Biology VII 65 doi:10.2495/BIO070071
DEMİRKIRAN, N.D. and Husemoglu, R.B., 2020. Finite Element Analysis of Unicondylar Knee Arthroplasty Combined with Proximal Fibular Osteotomy. Journal of Medical Innovation and Technology, 2(2), pp.121-126.
Pitta, M., Esposito, C.I., Li, Z., Lee, Y.Y., Wright, T.M. and Padgett, D.E., 2018. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. The Journal of arthroplasty, 33(2), pp.407-414.
JUNFEN SHI, 2007. FINITE ELEMENT ANALYSIS OF TOTAL KNEE REPLACEMENT CONSIDERING GAIT CYCLE LOAD AND MALALIGNMENT, PhD Thesis, University of Wolverhampton.
Smith & Nephew, 2011. Analyzes replacement joints with SIMULIA, Dassult Systems.
Kumbhalkar, et al, 2013. Modeling and Finite Element Analysis of Knee Prosthesis with and without Implant, Universal Journal of Computational Mathematics Vol. 1(2), pp. 56 – 66
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Ingrassia, T. Nalbone, L. Nigrelli, V. Tumino, D. and Ricotta, V.2012. Finite element analysis of two total knee joint prostheses. Springer-Verlag. 2012, DOI 10.1007/s12008-012-0167-7
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M. SONCINI , L. VANDINI , A. REDAELLI.2004. Finite element analysis of a knee joint replacement during a gait cycle. Journal of Applied Biomaterials & Biomechanics 2004; 2: 45-54
H. J. Park , T. S. Bae , S Kang , H. H. Baek, M. J. Chang, C. B. Chang. 2021. A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption. https://doi.org/10.1371/journal.pone.0246866
S. Yueh, M. Noori, S. Mahadev and N. B Noori.2021. Finite Element Analysis of Total Knee Arthroplasty. Am J Biomed Sci & Res. 2021 – 14(1). AJBSR.MS.ID.001942. DOI: 10.34297/AJBSR.2021.14.001942.