Abstract
Revision total knee arthroplasty (RTKA) is a highly complex procedure challenged by bone defects and compromised biomechanical stability, which may threaten implant fixation and long-term survivorship. This study aimed to introduce a novel cementless RTKA system and evaluate the resulting femoral initial stability. A novel cementless femoral RTKA system based on metaphyseal and biological fixation, comprising a femoral condyle component, metaphyseal cone, and optional intramedullary stems and metal augments, was evaluated using finite element analysis. The initial stability of the system was assessed in a CT-based femoral model under conditions with or without bone defects, at different defect locations, and with or without the use of intramedullary stems and metal augments. Finite element analysis demonstrated that, regardless of the presence of femoral bone defects, the system exhibited favorable interface micromotion and femoral stress distribution, indicating acceptable initial femoral stability. Intramedullary stems reduced micromotion but decreased the proportion of stress within the reference range, whereas metal augments produced only limited numerical improvement without being essential for initial stability. Within the investigated finite element model, the novel cementless RTKA system achieved acceptable initial femoral mechanical stability, even in the presence of femoral bone defects. Adequate initial stability could be obtained through metaphyseal fixation alone, while the additional use of intramedullary stems or metal augments provided limited incremental benefit.
Data availability
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
Funding support was provided from Beijing Municipal Science and Technology Program: Innovative Pharmaceutical Products and Platform Development Program (Z241100009024023), Beijing Natural Science Foundation (L254010, L234012), National Key Research and Development Program of China (2024YFB3814700), Clinical Cohort Construction Program of Peking University Third Hospital (BYSYDL2023007).
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Ziyang Dong and Xinguang Wang contributed equally to this work. Ziyang Dong and Xinguang Wang analyzed the data, interpreted the results, and drafted the main manuscript. Dongyang He, Xiaofan Lv, Ti Zhang, and Zijian Li contributed to the construction, analysis, and verification of the finite element analysis (FEA) model. Xiaogang Zhang and Hua Tian provided supervision, conceptual guidance, and administrative support. All authors reviewed and approved the final version of the manuscript.
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The study was approved by Peking University Third Hospital Medical Science Research Ethics Committee (M2021636). All procedures involving human participants were conducted in accordance with the Helsinki Declaration. Informed consent was also obtained from the participant in this study.
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Dong, Z., Wang, X., He, D. et al. Femoral finite element analysis of a novel cementless revision total knee arthroplasty system. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42423-0
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DOI: https://doi.org/10.1038/s41598-026-42423-0
