{"id":"https://openalex.org/W4414799108","doi":"https://doi.org/10.12680/balneo.2025.873","title":"Finite Element Analysis of Tibial Stem Extensions in Total Knee Arthroplasty: Influence of Varus\u2013Valgus Loading and Fatigue Resistance","display_name":"Finite Element Analysis of Tibial Stem Extensions in Total Knee Arthroplasty: Influence of Varus\u2013Valgus Loading and Fatigue Resistance","publication_year":2025,"publication_date":"2025-09-30","ids":{"openalex":"https://openalex.org/W4414799108","doi":"https://doi.org/10.12680/balneo.2025.873"},"language":"en","primary_location":{"id":"doi:10.12680/balneo.2025.873","doi":"https://doi.org/10.12680/balneo.2025.873","is_oa":true,"landing_page_url":"https://doi.org/10.12680/balneo.2025.873","pdf_url":"https://doi.org/10.12680/balneo.2025.873","source":{"id":"https://openalex.org/S4210207809","display_name":"Balneo and PRM Research Journal","issn_l":"2734-844X","issn":["2734-844X","2734-8458"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":["poland-20","russia-white-list-4","vabb-shw"],"host_organization":"https://openalex.org/I4405266397","host_organization_name":"Romanian Association of Balneology","host_organization_lineage":["https://openalex.org/I4405266397"],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Balneo and PRM Research Journal","raw_type":"journal-article"},"parent_works":[],"lineage":["https://openalex.org/W4414799108"],"child_works_count":0,"type":"article","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.12680/balneo.2025.873","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5046149799","display_name":"\u0218tefan Alexandru Cuculici","orcid":"https://orcid.org/0000-0002-4020-3115","observed_orcids":["https://orcid.org/0000-0002-4020-3115"]},"institutions":[{"id":"https://openalex.org/I2799655038","display_name":"Clinical Emergency Hospital Bucharest","ror":"https://ror.org/03grprm46","country_code":"RO","type":"healthcare","lineage":["https://openalex.org/I2799655038"]}],"countries":["RO"],"is_corresponding":false,"raw_author_name":"\u0218tefan Alexandru Cuculici","raw_affiliation_strings":["Department of Orthopedic Surgery, Ilfov County Emergency Clinical Hospital, 022104 Bucharest"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery, Ilfov County Emergency Clinical Hospital, 022104 Bucharest","institution_ids":["https://openalex.org/I2799655038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5081057178","display_name":"Florin Gro\u0219eanu","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2799655038","display_name":"Clinical Emergency Hospital Bucharest","ror":"https://ror.org/03grprm46","country_code":"RO","type":"healthcare","lineage":["https://openalex.org/I2799655038"]}],"countries":["RO"],"is_corresponding":false,"raw_author_name":"Florin Gro\u0219eanu","raw_affiliation_strings":["Department of Orthopedic Surgery and Trauma, \u201dSf. Pantelimon\u201d Emergency Clinical Hospital, 021659 Bucharest"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedic Surgery and Trauma, \u201dSf. Pantelimon\u201d Emergency Clinical Hospital, 021659 Bucharest","institution_ids":["https://openalex.org/I2799655038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5038082073","display_name":"Corneliu-Dan Blendea","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2799655038","display_name":"Clinical Emergency Hospital Bucharest","ror":"https://ror.org/03grprm46","country_code":"RO","type":"healthcare","lineage":["https://openalex.org/I2799655038"]}],"countries":["RO"],"is_corresponding":false,"raw_author_name":"Corneliu-Dan Blendea","raw_affiliation_strings":["Department of Rehabilitation, Ilfov County Emergency Clinical Hospital, Bucharest;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Rehabilitation, Ilfov County Emergency Clinical Hospital, Bucharest;","institution_ids":["https://openalex.org/I2799655038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031799626","display_name":"Doroteea Teoiba\u0219-\u0218erban","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2799655038","display_name":"Clinical Emergency Hospital Bucharest","ror":"https://ror.org/03grprm46","country_code":"RO","type":"healthcare","lineage":["https://openalex.org/I2799655038"]}],"countries":["RO"],"is_corresponding":false,"raw_author_name":"Doroteea Teoiba\u0219-\u0218erban","raw_affiliation_strings":["Department of Rehabilitation, Ilfov County Emergency Clinical Hospital, Bucharest;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Rehabilitation, Ilfov County Emergency Clinical Hospital, Bucharest;","institution_ids":["https://openalex.org/I2799655038"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5109982905","display_name":"\u0218tefan Cristea","orcid":"https://orcid.org/0000-0003-3878-3090","observed_orcids":["https://orcid.org/0000-0003-3878-3090"]},"institutions":[{"id":"https://openalex.org/I162051807","display_name":"Carol Davila University of Medicine and Pharmacy","ror":"https://ror.org/04fm87419","country_code":"RO","type":"education","lineage":["https://openalex.org/I162051807"]}],"countries":["RO"],"is_corresponding":false,"raw_author_name":"\u0218tefan Cristea","raw_affiliation_strings":["Department of Orthopaedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopaedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest","institution_ids":["https://openalex.org/I162051807"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":200,"currency":"EUR","value_usd":215},"apc_paid":{"value":200,"currency":"EUR","value_usd":215},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"16","issue":"Vol 16 No. 3","first_page":"873","last_page":"873"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10562","display_name":"Total Knee Arthroplasty Outcomes","score":0.9868000149726868,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10562","display_name":"Total Knee Arthroplasty Outcomes","score":0.9868000149726868,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10512","display_name":"Orthopaedic implants and arthroplasty","score":0.011599999852478504,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10442","display_name":"Knee injuries and reconstruction techniques","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/total-knee-arthroplasty","display_name":"total knee arthroplasty","score":0.9980000257492065},{"id":"https://openalex.org/keywords/fatigue-resistance","display_name":"fatigue resistance","score":0.6779999732971191},{"id":"https://openalex.org/keywords/stress-distribution","display_name":"stress distribution","score":0.9210000038146973},{"id":"https://openalex.org/keywords/tibial-tray","display_name":"tibial tray","score":0.6330000162124634},{"id":"https://openalex.org/keywords/polyethylene-insert","display_name":"polyethylene insert","score":0.8510000109672546},{"id":"https://openalex.org/keywords/cement-mantle","display_name":"cement mantle","score":0.8960000276565552},{"id":"https://openalex.org/keywords/micromotion","display_name":"micromotion","score":0.8059999942779541},{"id":"https://openalex.org/keywords/implant-survival","display_name":"implant survival","score":0.7379999756813049},{"id":"https://openalex.org/keywords/primary-knee-arthroplasty","display_name":"primary knee arthroplasty","score":0.6389999985694885},{"id":"https://openalex.org/keywords/malalignment","display_name":"malalignment","score":0.4399999976158142}],"concepts":[{"id":"https://openalex.org/C135628077","wikidata":"https://www.wikidata.org/wiki/Q220184","display_name":"Finite element method","level":2,"score":0.6758999824523926},{"id":"https://openalex.org/C2781017183","wikidata":"https://www.wikidata.org/wiki/Q7911553","display_name":"Valgus","level":2,"score":0.6546000242233276},{"id":"https://openalex.org/C3017871827","wikidata":"https://www.wikidata.org/wiki/Q1693864","display_name":"Total knee arthroplasty","level":2,"score":0.4900999963283539},{"id":"https://openalex.org/C29694066","wikidata":"https://www.wikidata.org/wiki/Q118301","display_name":"Orthodontics","level":1,"score":0.4675000011920929},{"id":"https://openalex.org/C21036866","wikidata":"https://www.wikidata.org/wiki/Q181767","display_name":"Stress (linguistics)","level":2,"score":0.4595000147819519},{"id":"https://openalex.org/C2779866876","wikidata":"https://www.wikidata.org/wiki/Q18349435","display_name":"High tibial osteotomy","level":4,"score":0.4207000136375427},{"id":"https://openalex.org/C180016635","wikidata":"https://www.wikidata.org/wiki/Q2712821","display_name":"Compression (physics)","level":2,"score":0.3801000118255615},{"id":"https://openalex.org/C66938386","wikidata":"https://www.wikidata.org/wiki/Q633538","display_name":"Structural engineering","level":1,"score":0.3481999933719635},{"id":"https://openalex.org/C2985278600","wikidata":"https://www.wikidata.org/wiki/Q65051469","display_name":"Fatigue testing","level":2,"score":0.3456999957561493},{"id":"https://openalex.org/C2781411149","wikidata":"https://www.wikidata.org/wiki/Q486975","display_name":"Implant","level":2,"score":0.3424000144004822},{"id":"https://openalex.org/C192562407","wikidata":"https://www.wikidata.org/wiki/Q228736","display_name":"Materials science","level":0,"score":0.3346000015735626},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.3343999981880188},{"id":"https://openalex.org/C28539199","wikidata":"https://www.wikidata.org/wiki/Q542690","display_name":"Stress concentration","level":3,"score":0.31360000371932983},{"id":"https://openalex.org/C170700871","wikidata":"https://www.wikidata.org/wiki/Q193378","display_name":"Biomechanics","level":2,"score":0.3095000088214874},{"id":"https://openalex.org/C2777236700","wikidata":"https://www.wikidata.org/wiki/Q178366","display_name":"Tibia","level":2,"score":0.30820000171661377},{"id":"https://openalex.org/C2780554211","wikidata":"https://www.wikidata.org/wiki/Q176503","display_name":"Femur","level":2,"score":0.30169999599456787},{"id":"https://openalex.org/C3019548353","wikidata":"https://www.wikidata.org/wiki/Q181802","display_name":"Prosthesis design","level":3,"score":0.2890999913215637},{"id":"https://openalex.org/C30407753","wikidata":"https://www.wikidata.org/wiki/Q186191","display_name":"Compressive strength","level":2,"score":0.2825999855995178},{"id":"https://openalex.org/C2986595273","wikidata":"https://www.wikidata.org/wiki/Q1693864","display_name":"Total knee replacement","level":2,"score":0.2768000066280365},{"id":"https://openalex.org/C3019066406","wikidata":"https://www.wikidata.org/wiki/Q64138885","display_name":"Knee prosthesis","level":3,"score":0.25769999623298645},{"id":"https://openalex.org/C2778891590","wikidata":"https://www.wikidata.org/wiki/Q1777319","display_name":"Bone cement","level":3,"score":0.25290000438690186},{"id":"https://openalex.org/C2778336525","wikidata":"https://www.wikidata.org/wiki/Q708178","display_name":"Arthroplasty","level":2,"score":0.2524999976158142}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.12680/balneo.2025.873","doi":"https://doi.org/10.12680/balneo.2025.873","is_oa":true,"landing_page_url":"https://doi.org/10.12680/balneo.2025.873","pdf_url":"https://doi.org/10.12680/balneo.2025.873","source":{"id":"https://openalex.org/S4210207809","display_name":"Balneo and PRM Research Journal","issn_l":"2734-844X","issn":["2734-844X","2734-8458"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":["poland-20","russia-white-list-4","vabb-shw"],"host_organization":"https://openalex.org/I4405266397","host_organization_name":"Romanian Association of Balneology","host_organization_lineage":["https://openalex.org/I4405266397"],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Balneo and PRM Research Journal","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.12680/balneo.2025.873","doi":"https://doi.org/10.12680/balneo.2025.873","is_oa":true,"landing_page_url":"https://doi.org/10.12680/balneo.2025.873","pdf_url":"https://doi.org/10.12680/balneo.2025.873","source":{"id":"https://openalex.org/S4210207809","display_name":"Balneo and PRM Research Journal","issn_l":"2734-844X","issn":["2734-844X","2734-8458"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":["poland-20","russia-white-list-4","vabb-shw"],"host_organization":"https://openalex.org/I4405266397","host_organization_name":"Romanian Association of Balneology","host_organization_lineage":["https://openalex.org/I4405266397"],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Balneo and PRM Research Journal","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.8048999905586243}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4414799108.pdf","grobid_xml":"https://content.openalex.org/works/W4414799108.grobid-xml"},"referenced_works_count":18,"referenced_works":["https://openalex.org/W2026989505","https://openalex.org/W2074777552","https://openalex.org/W2149257121","https://openalex.org/W2162816009","https://openalex.org/W2285556095","https://openalex.org/W2659592169","https://openalex.org/W4220828802","https://openalex.org/W4225245844","https://openalex.org/W4225275810","https://openalex.org/W4321458176","https://openalex.org/W4377041992","https://openalex.org/W4390651892","https://openalex.org/W4396830964","https://openalex.org/W4399610191","https://openalex.org/W4401494048","https://openalex.org/W4405678940","https://openalex.org/W4406085310","https://openalex.org/W4407373374"],"related_works":["https://openalex.org/W4399610191","https://openalex.org/W4225275810","https://openalex.org/W4415028628","https://openalex.org/W7166741055","https://openalex.org/W2379069365","https://openalex.org/W3182559433","https://openalex.org/W4413118599","https://openalex.org/W2137632226","https://openalex.org/W2181175855","https://openalex.org/W2529553519"],"abstract_inverted_index":{"Tibial":[0],"stem":[1,36,99],"extensions":[2],"are":[3],"widely":[4],"adopted":[5],"in":[6,15,156],"revision":[7],"total":[8],"knee":[9],"arthroplasty":[10],"(TKA),":[11],"yet":[12],"their":[13],"relevance":[14],"complex":[16],"primary":[17,158],"cases":[18],"is":[19],"not":[20],"fully":[21],"established.":[22],"This":[23],"finite":[24],"element":[25],"(FE)":[26],"analysis":[27],"compared":[28],"tibial":[29,53,136],"virtual":[30],"constructs":[31],"with":[32,68,129],"and":[33,43,60,70,77,93,145],"without":[34,83],"a":[35,84,130],"extension":[37],"to":[38,119,122],"assess":[39],"stress":[40],"distribution,":[41],"deformation,":[42],"fatigue":[44],"endurance.":[45],"The":[46],"model":[47],"included":[48],"the":[49,80],"femoral":[50],"component,":[51,55],"tibia,":[52],"tray":[54],"polyethylene":[56],"insert,":[57],"cement":[58],"mantle,":[59],"optional":[61],"stem,":[62,85],"tested":[63],"under":[64,91,96],"compressive":[65],"loading":[66],"combined":[67],"varus":[69,92],"valgus":[71],"angles":[72],"of":[73],"3\u00b0,":[74],"5\u00b0,":[75],"7\u00b0,":[76],"10\u00b0.":[78],"In":[79],"standard":[81],"configuration":[82],"peak":[86],"stresses":[87,103],"reached":[88],"~259":[89],"MPa":[90,95],"~300":[94],"valgus,":[97],"while":[98],"use":[100],"consistently":[101],"lowered":[102],"by":[104],"roughly":[105],"one":[106],"quarter.":[107],"Fatigue":[108],"performance":[109],"also":[110],"improved,":[111],"extending":[112],"survival":[113],"from":[114],"about":[115],"360,000":[116],"cycles":[117,126],"(equivalent":[118],"~2":[120],"years)":[121,128],"more":[123,141],"than":[124],"600,000":[125],"(>3\u20134":[127],"stem.":[131],"These":[132],"results":[133],"indicate":[134],"that":[135],"stems":[137],"help":[138],"distribute":[139],"loads":[140],"evenly,":[142],"restrict":[143],"micromotion,":[144],"enhance":[146],"long-term":[147],"durability.":[148],"Clinically,":[149],"such":[150],"benefits":[151],"may":[152],"be":[153],"most":[154],"relevant":[155],"demanding":[157],"TKA":[159],"scenarios,":[160],"including":[161],"severe":[162],"malalignment,":[163],"bone":[164,168],"loss,":[165],"or":[166],"compromised":[167],"stock.":[169]},"counts_by_year":[],"updated_date":"2026-11-13T13:42:25.865203","created_date":"2025-10-10T00:00:00"}