Analysis of a below-knee patellar tendon-bearing prosthesis: a finite element study.

In this study, a finite element (FE) model of a below-knee prosthesis of patellar tendon-bearing (PTB) design, and several altered variations of the model have been constructed. A load of approximately 1.5 times normal body weight (984 N) was applied at the heel of the model to simulate heelstrike conditions. The "base" model was then analyzed and revised iteratively until a model which provided consistency between soft tissue elastic modulus and socket displacement was developed. The interface normal and shear stresses obtained from the analysis of this revised base model were highest (about 961, and 463 KPa, respectively) at the distal anterior tip of the socket/stump. Proximally, higher normal stresses (72-78 KPa) were found medially and posteriorly. Proximal shear stresses were highest posteriorly (79 KPa), although shear stresses medially (51 KPa), and laterally (43 KPa), were also much higher than anteriorly (10 KPa). FE analyses were performed on the altered models to determine the relative effects on socket/stump interface stresses of altering the FE model of the prosthesis. Results of the analysis indicate that fabricating the prosthesis from a material with an elastic modulus ten times lower than that of the revised base model can produce reductions in the maximum pressure of up to 14 percent. Large decreases in maximum pressures (71 percent) resulted from the use of a suction socket rather than a conventional socket. Small changes in stump length (2 cm) caused relatively large pressure changes (16 to 18 percent).