{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:48:10Z","timestamp":1787755690577,"version":"build-2784847793"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Femoral pin-site fracture is one of the most serious complications of navigation-assisted total knee arthroplasty (TKA). Its occurrence is associated with the loss of biomechanical strength caused by intraoperative femoral drilling. This study aimed to investigate the drilling location as a risk factor for pin-site fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A biomechanical analysis using rabbit femora was performed to determine the effects of drilling eccentricity and height. Torsional, 3-point bending, and axial compression tests were performed to evaluate biomechanical parameters, including failure strength, failure displacement, and stiffness. Fracture type and the presence of comminution were noted and analyzed. Finite-element analysis (FEA) was utilized to assess the stress distribution and deformation. The cumulative sum (CUSUM) method was applied to define the safe range for drilling eccentricity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Drilling operations were accurately implemented. Biomechanical tests confirmed that severely eccentric drilling significantly reduced the biomechanical strength of the femur, especially in torsion. FEA results provided evidence of threatening stress concentration in severely eccentric drilling. The overall safe range of eccentricity relative to the center of the femur was found to be between 50% of the radius in the anterolateral direction and 70% of the radius in the posteromedial direction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Severely eccentric drilling significantly increased the risk of femoral pin-site fracture, especially under torsional stress. Femoral drilling should be performed in the safe zone that was identified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.01496","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T08:00:49Z","timestamp":1658304049000},"page":"1738-1749","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Biomechanical and Finite-Element Analysis of Femoral Pin-Site Fractures Following Navigation-Assisted Total Knee Arthroplasty"],"prefix":"10.2106","volume":"104","author":[{"given":"Houyi","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"},{"name":"Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-368X","authenticated-orcid":false,"given":"Haifeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8334-2476","authenticated-orcid":false,"given":"Tianhao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6248-6275","authenticated-orcid":false,"given":"Kai","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3513-4220","authenticated-orcid":false,"given":"Weicheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7638-9978","authenticated-orcid":false,"given":"Wenming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2076-496X","authenticated-orcid":false,"given":"Wen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Orthopedic Institute, Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0424-4884","authenticated-orcid":false,"given":"Yaozeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4375-2803","authenticated-orcid":false,"given":"Dechun","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"issue":"11","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"3565","DOI":"10.1007\/s00167-016-4337-1","article-title":"Current state of the art in total knee arthroplasty computer navigation","volume":"24","author":"Picard","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"11","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"3482","DOI":"10.1007\/s00167-016-4305-9","article-title":"Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis","volume":"24","author":"van der List","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"3","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"507","DOI":"10.2106\/00004623-197052030-00008","article-title":"The biomechanics of torsional fractures. 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