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Peer-reviewedCC BYArchives of orthopaedic and trauma surgery

Coronal alignment-related mediolateral load distribution and polyethylene wear in a medial-pivot total knee arthroplasty design.

  • Celina Lesnicar1
  • Manuel Kistler2
  • Christoph Thorwächter2
  • Irem Tural2
  • Johanna-Maria Simon2
  • Thomas Richard Niethammer2
  • Boris Michael Holzapfel2
  • Matthias Woiczinski2,3
  1. 1Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Ludwig-Maximilians-Universität München, Munich, Germany. [email protected].
  2. 2Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Ludwig-Maximilians-Universität München, Munich, Germany.
  3. 3Experimental Orthopaedics University Hospital Jena, Waldkliniken Eisenberg, Friedrich Schiller University Jena, Jena, Germany.
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Abstract

Introduction

While mechanical alignment in total knee arthroplasty aims for a neutral hip-knee-ankle angle, kinematic alignment preserves the native joint line, often allowing residual varus or valgus. Clinically, constitutional variations in alignment affect the coronal joint moments and the mediolateral load distribution, but the impact on polyethylene wear remains unclear.Materials and methods

Wear of a medial pivot total knee arthroplasty insert (MS 5C®, implantcast GmbH, Germany) was evaluated in a knee wear simulator replicating the walking cycle. Inserts were tested under three conditions representing overall lower-limb coronal alignment and the associated mediolateral load distribution: neutral (60% medial / 40% lateral), varus (70% / 30%), and valgus (50% / 50%), with three (n = 3) dynamically loaded inserts and one load-soak control per condition. Testing followed ISO 14243-1:2009 over 5 million cycles. Gravimetric wear and wear patterns were assessed.Results

A numerical trend was observed among the groups: The varus-related load distribution demonstrated the lowest overall wear (4.83 ± 1.06 mg/million cycles), whereas the valgus group produced the highest wear (9.43 ± 1.47 mg/million cycles); the neutral group was intermediate (6.81 ± 3.07 mg/million cycles). However, these differences did not reach statistical significance. Visual inspection revealed medial-dominant wear in all groups, with increased lateral wear under valgus-related load distribution.Conclusions

Overall lower-limb coronal alignment and the associated mediolateral load distribution appear to influence polyethylene wear in total knee arthroplasty. The observed numerical trend suggests that alignment-related changes in mediolateral load distribution may influence polyethylene wear patterns in this medial-pivot TKA design. Further studies are required to determine the clinical relevance of these observations.

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Cite

BibTeXRIS
BibTeX
@article{lesnicar2026coronal,
  title = {{Coronal alignment-related mediolateral load distribution and polyethylene wear in a medial-pivot total knee arthroplasty design.}},
  author = {Celina Lesnicar and Manuel Kistler and Christoph Thorwächter and Irem Tural and Johanna-Maria Simon and Thomas Richard Niethammer and Boris Michael Holzapfel and Matthias Woiczinski},
  journal = {Archives of orthopaedic and trauma surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s00402-026-06558-z},
  url = {https://europepmc.org/article/MED/42961518},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Coronal alignment-related mediolateral load distribution and polyethylene wear in a medial-pivot total knee arthroplasty design.
AU  - Celina Lesnicar
AU  - Manuel Kistler
AU  - Christoph Thorwächter
AU  - Irem Tural
AU  - Johanna-Maria Simon
AU  - Thomas Richard Niethammer
AU  - Boris Michael Holzapfel
AU  - Matthias Woiczinski
PY  - 2026
DA  - 2026/10/30
JO  - Archives of orthopaedic and trauma surgery
DO  - 10.1007/s00402-026-06558-z
UR  - https://europepmc.org/article/MED/42961518
AB  - Introduction  While mechanical alignment in total knee arthroplasty aims for a neutral hip-knee-ankle angle, kinematic alignment preserves the native joint line, often allowing residual varus or valgus. Clinically, constitutional variations in alignment affect the coronal joint moments and the mediolateral load distribution, but the impact on polyethylene wear remains unclear.Materials and methods  Wear of a medial pivot total knee arthroplasty insert (MS 5C®, implantcast GmbH, Germany) was evaluated in a knee wear simulator replicating the walking cycle. Inserts were tested under three conditions representing overall lower-limb coronal alignment and the associated mediolateral load distribution: neutral (60% medial / 40% lateral), varus (70% / 30%), and valgus (50% / 50%), with three (n = 3) dynamically loaded inserts and one load-soak control per condition. Testing followed ISO 14243-1:2009 over 5 million cycles. Gravimetric wear and wear patterns were assessed.Results  A numerical trend was observed among the groups: The varus-related load distribution demonstrated the lowest overall wear (4.83 ± 1.06 mg/million cycles), whereas the valgus group produced the highest wear (9.43 ± 1.47 mg/million cycles); the neutral group was intermediate (6.81 ± 3.07 mg/million cycles). However, these differences did not reach statistical significance. Visual inspection revealed medial-dominant wear in all groups, with increased lateral wear under valgus-related load distribution.Conclusions  Overall lower-limb coronal alignment and the associated mediolateral load distribution appear to influence polyethylene wear in total knee arthroplasty. The observed numerical trend suggests that alignment-related changes in mediolateral load distribution may influence polyethylene wear patterns in this medial-pivot TKA design. Further studies are required to determine the clinical relevance of these observations.
SN  - 0936-8051
SN  - 1434-3916
ER  -