Malalignment of the tibial tray in total knee arthroplasty has been linked to several complications including tibial tray subsidence, leading to revision surgery. However, quantitative biomechanical evidence to directly support the mechanism of failure is not available. We developed a model to study tibial tray micromotion and subsidence in vitro under multiaxial physiological loading conditions for up to 100,000 cycles. In Phase I, we tested four cadaver knees and two surrogate bone models to determine whether the surrogate models could reproduce the fatigue damage induced by cyclic loading. In Phase II, we tested six cadaver knees in a pairwise manner under conditions representing either neutral or varus malalignment.
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Shantanu Patil (2013) studied this question.
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