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Effect of malalignment on knee joint contact mechanics

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posted on 2023-08-30, 14:07 authored by Franziska Reisse
Osteoarthritis (OA) is a debilitating joint disease that leads to significant pain, loss of mobility and quality of life. Knee malalignment results in increased joint pressure, which is a primary cause for OA progression. High Tibial Osteotomy (HTO) is a surgical procedure to correct malalignment and redistribute load in the knee joint, reduce peak pressure and delay OA progression. However, clinical outcomes have been unpredictable. Therefore, the aim of this study was to determine the relationship between malalignment and knee contact mechanics. A 3D computational model was created from magnetic resonance images of a cadaveric knee joint. A ligament tuning process was conducted to determine material properties. Finite element analyses were conducted, simulating end of weight acceptance during walking. Different wedge geometries were virtually removed to simulate malalignments from 14° valgus to 16° varus. Contact mechanics were sensitive to soft tissue material properties. In-vitro experiments were compared with computational modelling of the same specimen. Percent full-scale errors for contact force and pressure were less than 8%, demonstrating a unique subject-specific model validation. The native alignment of the cadaveric knee (1° varus) had medial and lateral compartment peak pressures of 4.28 MPa and 2.42 MPa, respectively. The medial:lateral force ratio was 70%:30%. Minimum contact stress did not occur at a Mechanical Axis Deviation (MAD) of zero millimetres nor at the Fujisawa Point, which are common targets for HTO correction. Results showed very strong correlations (r >0.94) between MAD and joint contact loading. This study is the first to demonstrate the relationship between stress (normal, shear, contact pressure) and MAD in a subject-specific model. This is a prerequisite for the development of a tool that could help surgeons make informed decisions on the degree of realignment required to minimise peak joint loading, thereby delaying OA progression.



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