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Grupp, Thomas M.; Saleh, Khaled J.; Holderied, Melanie; Pfaff, Andreas M.; Schilling, Christoph; Schröder, Christian and Mihalko, William M. (2017): Primary stability of tibial plateaus under dynamic compression-shear loading in human tibiae - Influence of keel length, cementation area and tibial stem. In: Journal of Biomechanics, Vol. 59: pp. 9-22

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The objective of our study was to evaluate the impact of the tibial keel & stem length in surface cementation, of a full cemented keel and of an additional tibial stem on the primary stability of a posterior stabilised tibial plateau (VEGA (R) System Aesculap Tuttlingen, Germany) under dynamic compression-shear loading conditions in human tibiae. We performed the cemented tibial plateau implantations on 24 fresh-frozen human tibiae of a mean donor age of 70.7 years (range 47-97). The tibiae were divided into four groups of matched pairs based on comparable trabecular bone mineral density. To assess the primary stability under dynamic compression shear conditions, a 3D migration analysis of the tibial component relative to the bone based on displacements and deformations and an evaluation of the cement layer including penetration was performed by CT-based 3D segmentation. Within the tested implant fixation principles the mean load to failure of a 28 mm keel and a 12 mm stem (40 mm) was 4700 +/- 1149 N and of a 28 mm keel length was 4560 +/- 1429 N (p = 0.996), whereas the mean load to failure was 4920 +/- 691 N in full cementation (p = 0.986) and 5580 +/- 502 N with additional stem (p = 0.537), with no significant differences regarding the dynamic primary stability under dynamic compression-shear test conditions. From our observations, we conclude that there is no significant difference between a 40 mm and a 28 mm tibial keel & stem length and also between a surface and a full cementation in the effect on the primary stability of a posterior stabilised tibial plateau, in terms of failure load, migration characteristics and cement layer thickness including the penetration into the trabecular bone.

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