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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 5, 656-663.
doi: 10.1302/0301-620X.87B5.15860  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Mechanical testing of impaction bone grafting in the tibia

INITIAL STABILITY AND DESIGN OF THE STEM

A. D. Toms, MSc, FRCS (Tr & Orth), Specialist Registrar1; D. McClelland, FRCS (Tr & Orth), Specialist Registrar1; L. Chua, MSc, Research Assistant1; M. de Waal Malefijt, MD, PhD, Orthopaedic Surgeon2; N. Verdonschot, PhD, Professor of Biomechanics2; R. Spencer Jones, FRCS (Tr & Orth), Consultant Orthopaedic Surgeon1; and J.-H. Kuiper, PhD, Lecturer in Biomechanics1

1 The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK.
2 University Medical Centre, Nijmegen, The Netherlands.

Correspondence should be sent to Mr A. D. Toms at 1706-1228 Marinaside Crescent, Vancouver, British Columbia V6Z 2W4, Canada; e-mail: TOMS{at}at-rj.freeserve.co.uk

Clinical experience of impaction bone grafting for revision knee arthroplasty is limited, with initial stability of the tibial tray emerging as a major concern. The length of the stem and its diameter have been altered to improve stability. Our aim was to investigate the effect of the type of stem, support of the rim and graft impaction on early stability of the tray.

We developed a system for impaction grafting of trays which we used with morsellised bone in artificial tibiae. Trays with short, long thick or long thin stems were implanted, with or without support of the rim. They were cyclically loaded while measuring relative movement.

Long-stemmed trays migrated 4.5 times less than short-stemmed trays, regardless of diameter. Those with support migrated 2.8 times less than those without. The migration of short-stemmed trays correlated inversely with the density of the impacted groups. That of impaction-grafted tibial trays was in the range reported for uncemented primary trays. Movements of short-stemmed trays without cortical support were largest and sensitive to the degree of compaction of the graft. If support of the rim was sufficient or a long stem was used, impacted morsellised bone graft achieved adequate initial stability.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General