We previously combined experimental and computational measures to ascertain whether tibial stem augmentation reduces bone
strains beneath constrained condylar implants. Using these same integrated approaches, we examined the benefit of a stem when
a wedge is used. Implants were removed from the eight paired cadaver specimens from our previous experiment, and oblique defects
created that were restored with 15° metallic wedges cemented in place. We applied a varus moment and an axial load and monitored
relative motion between implant and bone. Specimen-specific 3-D finite element models were constructed from CT scans and radiographs
to examine bone stress in the proximal tibia. Implants with a wedge but no stem had greater motion than the previous control
with no stem or wedge. Use of a modular stem with a wedge maintained the same level of motion as the primary case, suggesting
that a stem is preferable when a wedge is utilized. The computational models confirmed this conclusion with a 30% reduction
in bone stress compared to 17% in the primary case without a wedge. The wedge carried more axial load compared to the primary
implant due to its support on stiff metaphyseal bone.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
The Clark and Kirby Foundations provided financial support.
Each author certifies that his or her institution either has waived or does not require approval for the human protocol for
this investigation and that all investigations were conducted in conformity with ethical principles of research.