ArticleOrthopaedic surgery2025
Comprehensive Impact of Multiplanar Malalignment on Prosthetic Mechanics Under Gait Loading After Total Knee Arthroplasty-A Finite Element Analysis.
Article in Orthopaedic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Impact of flexion contracture severity on early outcomes of computer-navigated total knee arthroplasty: a retrospective cohort study.Journal of orthopaedic surgery and research · 2026Article
- [Finite element analysis of tibial and femoral resection configurations on varus alignment in total knee arthroplasty].Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundComponent alignment is a key factor influencing clinical outcomes after total knee arthroplasty (TKA). Previous studies have shown that single-plane alignment can significantly affect knee joint kinematics and biomechanics. However, the comprehensive impact of multiplanar malalignment has been rarely investigated.
objectiveThis study aimed to investigate the influence of the multiplanar malalignment combination on the polyethylene tibial liners under gait loading, a primary activity of daily life, as well as the degree of the influence of the alignments on the different planes.
methodA validated finite element model of a cruciate-retaining knee prosthesis under gait loading was used in this study. Five alignment parameters (-5°, -3°, 0°, 3°, 5°) on each plane (coronal, sagittal, and transverse) were selected to simulate clinical alignment errors, resulting in 125 models combining various alignment errors across the three planes. Boundary and loading conditions were set according to ISO 14243-3:2014. The maximum von Mises stress and contact stress during a gait cycle were recorded for statistical analysis. A polynomial model was used for regression analysis, with the degree of influence of each alignment error on von Mises and contact stress determined by examining the quadratic coefficients.
resultsThe highest Mises and contact stress values occurred with alignment errors of 5° varus, 5° flexion, and 5° internal rotation on the coronal, sagittal, and transverse planes, respectively. The lowest stress values were observed with a combination of 3° valgus, 5° flexion, and 0° internal rotation. The regression analysis yielded an R
conclusionThe coronal alignment of the lower limb has the most significant impact on both Mises stress and contact stress of the tibial liner, followed by the rotational alignment of the tibial component. In contrast, the sagittal alignment of the femoral component has the least influence.
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