Distribution of bone strength in the proximal tibia.

Indentation tests were used to determine the ultimate strength of the proximal tibia. Measurements were made at the subchondral bone surface and on transverse planes up to 25 mm below the surface. Medial condyles were stronger than lateral condyles, and in both cases bone strength decreased abruptly with distance from the surface, especially over the first 5 mm. The mean bone strength was greater in men than in women in both condyles, especially in the harder upper layers. The areas of greatest strength on both the medial and lateral sides varied with depth. At the surface, maximum strength in the medial region was more posterior in men than in women. With increasing depth, the area shifted medially in the medial region and laterally in the lateral region. Spatial distribution of strength across planes of the tibia seems consistent with anticipated patterns of load distribution in weight bearing and with the contiguity of the trabecular bone. The data are relevant to an understanding of normal joint mechanics and to the design and placement of prostheses in total knee arthroplasty.