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Several ongoing studies aim to improve the survival rate following total knee arthroplasty (TKA), which is an effective orthopedic surgical approach for patients with severely painful knee joint diseases. Among the studied strategies, baseplate rotational arrangement techniques for TKA components have been suggested but have been the subject of only simple reliability evaluations. Therefore, this study sought to evaluate comparatively three different baseplate rotational arrangement techniques that are commonly used in a clinical context.Materials and Methods   Three-dimensional (3D) finite element (FE) models of the proximal tibia with TKA were developed and analyzed considering three baseplate rotational arrangement techniques (anterior cortex line, tibial tuberosity one-third line, and tibial tuberosity end line) for six activities of daily life (ADLs) among patients undergoing TKA. Mechanical tests based on the ASTM F1800 standard to validate the FE models were then performed using a universal testing machine. To evaluate differences in biomechanical characteristics according to baseplate rotational arrangement technique, the strain and peak von Mises stresses (PVMSs) were assessed.Results   The accuracy of the FE models used in this study was high (94.7 ± 5.6%). For the tibial tuberosity one-third line rotational arrangement technique, strains ≤ 50  µ strain (the critical bone damage strain, which may affect bone remodeling) accounted for approximately 2.2%–11.3% and PVMSs within the bone cement ranged from 19.4 to 29.2 MPa, in ADLs with high loading conditions. For the tibial tuberosity end line rotational arrangement, strains ≤ 50  µ strain accounted for approximately 2.3%–13.3% and PVMSs within the bone cement ranged from 13.5 to 26.7 MPa. For anterior cortex line rotational arrangement techniques, strains ≤50  µ strain accounted for approximately 10.6%–16.6% and PVMSs within the bone cement ranged from 11.6 to 21.7 MPa.Conclusion   The results show that the most recently developed frontal cortex line rotational alignment technique is the same or better than the other two rotational alignment techniques in terms of biomechanics. This finding can be, however, dependent on the contact characteristics between the baseplate and the proximal tibia. That is, it is indicated that the optimum baseplate rotational arrangement technique in terms of reducing the incidence of TKA mechanical failure can be achieved by adjusting the characteristics of contact between the baseplate and the proximal tibia.

Biomechanical Characteristics of Three Baseplate Rotational Arrangement Techniques in Total Knee Arthroplasty