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In total knee arthroplasty (TKA) force is transmitted into the tibia by acombined plate-stem device along with cemented or cementless stem fixation. Thepresent work analyzes this force transmission in finite element simulationswith the main aim to avoid reported postsurgical bone density reduction as aconsequence of a reduced tibial bone loading. In the numerical analysisdifferent implant materials, stem/extension lengths and implant-to-steminterface conditions are considered, from a stiff fully cemented fixation tosliding contact conditions with a low friction coefficient. The impact of thesevariations on bone loading changes are measured by (i) decomposing the totalforce into parts mediated by the plate and by the stem and by (ii) post-surgerystrain energy density (SED) deviations. Based on a bionics-inspired perspectiveon how nature in pre-operative conditions carries out force transfer from theknee joint into the tibia, a modified implant-bone interface is suggested thatalters force transmission towards physiological conditions while preserving thegeometries of the standard plate-stem endoprosthesis design. The key aspect isthat the axial force is predominantly transmitted through the plate intoproximal bone which requires a compliant bone-stem interface as realized bysliding friction conditions at a low friction coefficient. These interfaceconditions avoid stress shielding almost completely, preserve pre-surgery boneloading such that bone resorption is not likely to occur.

Tibial Implant Fixation in TKA Worth A Revision? -- How to Avoid Stress-Shielding Even for Stiff Metallic Implants