ArticleFrontiers in bioengineering and biotechnology2025
Biomechanical optimization study of posterior tilt extension stems in the repair of tibial plateau bone defects.
Article in Frontiers in bioengineering and biotechnology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Tibial plateau bone defect represents a pivotal challenge in revision knee arthroplasty, where suboptimal extension stem design predisposes to stress concentration and subsequent prosthesis loosening. Physiological posterior tibial slope (5°-7°) optimizes knee biomechanics, yet bone defects disrupt proximal tibial anatomy, rendering traditional stems biomechanically incompatible. The synergistic optimization of "defect severity-stem length-posterior tilt angle" remains underexplored. Methods: A finite element model was constructed incorporating three defect areas (20%, 40%, 60%), two stem lengths (40mm, 80 mm), and five posterior tilt angles (0°-10°), yielding 30 experimental cohorts. Under 2450N axial loading, stress distribution (cortical/cancellous bone, prosthesis, sleeve) and bone-prosthesis micromotion were quantitatively evaluated. Results: All micromotion magnitudes remained below the 150 μm osseointegration threshold. In 20% defects, 40 mm stems with ≤7° tilt mitigated cortical stress concentration; 80 mm stems showed lower micromotion but excessive cancellous stress at 10° tilt. In 40%/60% defects, increasing tilt reduced micromotion (37.3%/45.3% reduction), with 80 mm stems exhibiting superior stability. Extreme tilt (10°) in long stems exacerbated cortical stress and prosthesis load. Conclusion: Based on the finite element analysis results, this study provides a hypothetical reference for the selection of posterior tilt angles of extension stems in the repair of tibial plateau defects: a posterior tilt angle of ≤7° is suggested for 20% defects when using a 40 mm stem; 7°-10° for 40% defects when using an 80 mm stem; and 5°-7° for 60% defects when using an 80 mm stem. This preliminary biomechanical finding offers a basis for exploring personalized implant design, while the realization of precision-based repair and improved prosthesis longevity requires further validation by multi-center clinical data, diverse patient anatomical models (e.g., differences in tibial size and medullary canal morphology), and
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