A finite element analysis of tibial tritanium cones without stems in varying bone defects

Shuqiao Xie, Noel Conlisk, David Hamilton, Chloe Scott, Richard Burnett, Pankaj Pankaj*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: In the UK around 10% of hip and knee arthroplasties are revision operations. At revision total knee arthroplasty (rTKA), bone loss management is critical to achieving a stable bone-implant construct. Though tritanium cones have been used to manage bone defects in rTKA, their biomechanical performance with varying defects remains unknown.

Methods: Uncontained tibial bone defects at four anatomic locations, with varying depths and widths (Type T2A and T2B) were investigated computationally in a composite tibia which was subjected to four loading scenarios. The ability of the tritanium cone to replace the tibial bone defect was examined using the outcome measures of bone strain distribution and interface micromotions.

Results: It was found that anterior and lateral defects do not significantly alter the strain distribution compared with intact bone. For medial defects, strain distribution is sensitive to defect width; while strain distributions for posterior defects are associated with defect width and depth. In general, micromotions at the bone-implant interface are small and are primarily influenced by defect depth.

Conclusions: Our models show that the cone is an acceptable choice for bone defect management in rTKA. Since all observed micromotions were small, successful osteointegration would be expected in all types of uncontained defects considered in this study. Tritanium cones safely accommodate uncontained tibial defects up to 10 mm deep and extending up to 9 mm from the centre of the cone. Medial and posteriorly based defects managed with symmetric cones display the greatest bone strains and asymmetric cones may be useful in this context.

Original languageEnglish
Pages (from-to)656-666
Number of pages11
JournalThe Knee
Issue number3
Publication statusPublished - 1 Jun 2020


  • bone defects
  • fnite element analysis
  • micromotion
  • principal strain
  • revision knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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