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  • Title: Stability of Three-Dimensional Printed Custom-Made Metaphyseal Cone for Tibial Bone Defects Reconstruction: A Finite Element Analysis and Biomechanical Study.
    Author: Wang X, Li X, Wang C, Geng X, Chen B, Dong Z, Li Y, Zhao M, Li Z, Li F, Wang C, Tian H.
    Journal: Orthop Surg; 2023 Nov; 15(11):2937-2946. PubMed ID: 37712186.
    Abstract:
    OBJECTIVES: The reconstruction of bone defects in tibial revision knee arthroplasty is challenging. In this study, we evaluated the primary stability of a novel three-dimensional (3D)-printed custom-made metaphyseal cone for Anderson Orthopedic Research Institute (AORI) IIb or III bone defect reconstruction in tibial revision knee arthroplasty using the combination of finite-element analysis and biomechanical experiments. METHODS: In the finite-element analysis, AORI II b and III medial tibial bone defects were designed at varying depths. A novel 3D-printed custom-made metaphyseal cone was designed and used to reconstruct the bone defect with or without a stem in simulated revision total knee arthroplasty (RTKA). A no-stem group and a stem group were established (based on whether a stem was used or not). Von Mises stress and micromotion were calculated with varying depths of bone defects, ranging from 5 mm to 35 mm, and then micromotions at the bone-implant interface were calculated and compared with the critical value of 150 μm. In the biomechanical experiment, the no-stem group was used, and the same bone defects were made in four synthetic tibias using patient-specific instruments. Micromotions at the bone-implant interface were investigated using a non-contact optical digital image correlation system and compared with the critical value of 150 μm. RESULTS: When the bone defect was <30 mm, micromotions at the bone-implant interface in the finite-element analysis were all below 150 μm both in the stem groups and no-stem groups, whereas those in the biomechanical experiment were also below 150 μm in the no-stem group. CONCLUSIONS: The 3D-printed custom-made metaphyseal cone in RTKA has excellent primary stability and does not require stems in reconstructing tibial AORI type IIb or III bone defects with a depth of <30 mm.
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