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Effect of Axial and Coronal Malalignment on Polyethylene Stresses in Lumbosacral Total Joint Replacement: A Finite Element Study
Journal article   Open access   Peer reviewed

Effect of Axial and Coronal Malalignment on Polyethylene Stresses in Lumbosacral Total Joint Replacement: A Finite Element Study

Steven A. Rundell, Steven M Kurtz, Hannah Spece, Scott D. Hodges and Ronald V Yarbrough
Bioengineering, v 13(9), 987
27 Aug 2026
DOI: https://doi.org/10.3390/bioengineering13090987
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url
https://doi.org/10.3390/bioengineering13090987View
Published, Version of Record (VoR) Open Access Discount via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

The purpose of this study was to analyze the sensitivity of polyethylene stresses and strains, as proxies for wear and surface damage, to coronal and axial misalignment for a novel lumbar total joint replacement (LTJR) implanted at L5-S1. We hypothesized that these stresses and strains would remain below the levels associated with worst-case impingement in a spine wear simulator. A finite element model (FEM) of the L4-S1 spine was developed using CT-based anatomy from a representative Investigational Device Exemption study patient. An appropriately sized LTJR was virtually implanted at L5-S1 in a standardized baseline orientation, and component positioning was altered to achieve eight independent misalignment scenarios, spanning axial convergence angle, anterior–posterior offset, and coronal tilt. Physiologic forward-bending loads were applied, and polyethylene contact pressure, von Mises stress, and effective strain were recorded. Peak values for the baseline scenario were 35.0 MPa, 19.9 MPa, and 4.8%, respectively. Convergence angle and anterior–posterior offset had minimal effect, whereas coronal tilt produced the largest changes. Contact pressure and von Mises stress varied by <20% due to misalignment, whereas effective strain was more sensitive, increasing from 4.8% at baseline to 9.9% with 20 degrees of coronal tilt. All values were comparable to prior L4-L5 findings and remained well below impingement levels. Within the bounds of reasonable misalignment, the device maintained bearing congruency and did not approach conditions associated with accelerated wear.

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