Trabecular bone strength at the knee.

The axial strength of trabecular bone at the knee is critical for the maintenance of support and fixation of the prosthetic components after total surface knee arthroplasty. The resistance of trabecular bone to penetration was measured posteriorly, centrally, and anteriorly in each of the tibial and femoral condyles in 150 consecutive total knee arthroplasties. Forty-seven rheumatoid knees and 88 osteoarthritic knees were evaluated. The correlation of bone strength with selected clinical parameters was found to be too poor to predict bone strength. Tibial bone strength was lower in rheumatoid than in osteoarthritic knees. Steroid medication did not influence tibial bone strength in rheumatoid arthritis. The distribution of bone strength between the medial and lateral condyles was closely dependent on knee alignment, with high medial strength in varus knees. At the unloaded condyle, strength was reduced relative to the findings for normally aligned knees. At the tibia, strength decreased with depth from the resection surface, while at the femur the converse was true. Tibial bone strength, both condylar and overall average, was lower than values reported in studies of normal cadaver knees. Evaluation of the absolute bone strength at the tibial condyles suggested that the values too low to meet load-bearing requirements after well-aligned knee replacement were infrequent.