{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:25:28Z","timestamp":1791390328589,"version":"4.3.3"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2016YFC1101904"],"award-info":[{"award-number":["2016YFC1101904"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Component alignment is a key factor influencing clinical outcomes after total knee arthroplasty (TKA). Previous studies have shown that single\u2010plane alignment can significantly affect knee joint kinematics and biomechanics. However, the comprehensive impact of multiplanar malalignment has been rarely investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to investigate the influence of the multiplanar malalignment combination on the polyethylene tibial liners under gait loading, a primary activity of daily life, as well as the degree of the influence of the alignments on the different planes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A validated finite element model of a cruciate\u2010retaining knee prosthesis under gait loading was used in this study. Five alignment parameters (\u22125\u00b0, \u22123\u00b0, 0\u00b0, 3\u00b0, 5\u00b0) on each plane (coronal, sagittal, and transverse) were selected to simulate clinical alignment errors, resulting in 125 models combining various alignment errors across the three planes. Boundary and loading conditions were set according to ISO 14243\u20103:2014. The maximum von Mises stress and contact stress during a gait cycle were recorded for statistical analysis. A polynomial model was used for regression analysis, with the degree of influence of each alignment error on von Mises and contact stress determined by examining the quadratic coefficients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The highest Mises and contact stress values occurred with alignment errors of 5\u00b0 varus, 5\u00b0 flexion, and 5\u00b0 internal rotation on the coronal, sagittal, and transverse planes, respectively. The lowest stress values were observed with a combination of 3\u00b0 valgus, 5\u00b0 flexion, and 0\u00b0 internal rotation. The regression analysis yielded an <jats:italic>R<\/jats:italic>\n<jats:sup>2<\/jats:sup> value of 0.69 between alignment errors and Mises stress, with quadratic coefficients of 0.096, 0.013, and 0.064 for the coronal, sagittal, and transverse alignments, respectively. For contact stress, the <jats:italic>R<\/jats:italic>\n<jats:sup>2<\/jats:sup> was 0.697, with quadratic coefficients of 0.083, 0.002, and 0.026 for the coronal, sagittal, and transverse alignments, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The coronal alignment of the lower limb has the most significant impact on both Mises stress and contact stress of the tibial liner, followed by the rotational alignment of the tibial component. In contrast, the sagittal alignment of the femoral component has the least influence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.70068","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T02:03:45Z","timestamp":1748397825000},"page":"2112-2120","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comprehensive Impact of Multiplanar Malalignment on Prosthetic Mechanics Under Gait Loading After Total Knee Arthroplasty\u2014A Finite Element Analysis"],"prefix":"10.1111","volume":"17","author":[{"given":"Yichao","family":"Luan","sequence":"first","affiliation":[{"name":"School of Biological Science and Medical Engineering Beihang University  Beijing China"},{"name":"Beijing Naton Medical Research Institute Co., Ltd  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Biological Science and Medical Engineering Beihang University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Beijing Naton Medical Research Institute Co., Ltd  Beijing China"},{"name":"Beijing Medical Implant Engineering Research Center Beijing Naton Technology Group Co., Ltd  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongping","family":"Duan","sequence":"additional","affiliation":[{"name":"Beijing Medical Implant Engineering Research Center Beijing Naton Technology Group Co., Ltd  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Beijing Chaoyang Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-999X","authenticated-orcid":false,"given":"Zhichang","family":"Li","sequence":"additional","affiliation":[{"name":"Arthritis Clinical and Research Center Peking University People's Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-6873","authenticated-orcid":false,"given":"Cheng\u2010Kung","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.106B10.BJJ-2023-1425.R1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.03.021"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.04.084"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-018-9614-8"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.92B9.24394"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-024-07925-w"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2024.101325"},{"key":"e_1_2_9_9_1","volume-title":"The National Joint Registry 20th Annual Report 2023","author":"Achakri H.","year":"2022"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2023.04.020"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01534"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4823-0"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.991476"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-017-5477-4"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.04.034"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2021.673275"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2022.910311"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1302\/2046-3758.611.BJR-2016-0088.R2"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1696958"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1736604"},{"issue":"6","key":"e_1_2_9_21_1","first-page":"43","article-title":"Tibial Tray Rotation and Posterior Slope Increase Risk for Outliers in Coronal Alignment","volume":"102","author":"D'Lima D. 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