Influence of an interpositional spacer on the behaviour of the tibiofemoral joint: A finite element study
Influence of an interpositional spacer on the behaviour of the tibiofemoral joint: A finite element study
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DOI：
10.1016/j.clinbiomech.2008.04.006
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发表时间：
2008-10-01
影响因子：
1.8
通讯作者：
New, A.
中科院分区：
文献类型：
--
作者：
Checa, S.;Taylor, M.;New, A.
背景间置关节成形术被许多外科医生认为是治疗孤立性膝关节内侧间室骨关节炎的方法。在该手术中，将间置间隔器插入关节内侧间室，不进行骨切除和机械固定。主要的问题，如植入物脱位，严重的疼痛或需要翻修手术后已报告。在本研究中，使用有限元分析预测了植入由聚氨酯或钴-慢性制成的间置垫片的膝关节在行走、爬楼梯和下蹲周期期间的运动学，并与正常膝关节进行了比较。另外。研究了关节软骨的应力历史，以获得累积应力的分布，这是关节软骨退化可能性的量度。与正常膝关节相比，在膝关节内侧插入聚氨酯间置垫片不会影响膝关节运动学，但会导致关节内侧间室关节软骨累积接触应力暴露增加。植入Co-Cr垫片的膝关节在膝关节运动学方面表现出相似的趋势，但是在活动周期的某些时间段内观察到显著不同的活动范围，特别是在步行周期的前半段，预测活动范围较低。另外。在膝关节的两个隔室中观察到较高的关节软骨累积接触应力暴露。在这两种情况下，胫骨关节软骨的累积接触应力暴露比股骨关节软骨更受影响。这些结果表明，植入材料的所有重要参数在设计阶段的插入间隔。(C)2008爱思唯尔有限公司保留所有权利。
Background. Interpositional arthroplasty is considered by many surgeons for the treatment of isolated medial compartment ostcoarthritis of the knee. In this procedure, an interpositional spacer is inserted into the medial compartment of the joint with no bone resection and no mechanical fixation. Major problems such as implant dislocation, severe pain or need for revision have been reported post-operatively.Methods. In this study, the kinematics of a knee implanted with an interpositional spacer made of either polyurethane or cobalt-chronic during walking, stair ascent and squatting Cycles have been predicted and compared to the normal knee using finite element analysis. In addition. articular cartilage stress histories have been examined to obtain distributions of cumulative stress, a measure of the likelihood of articular cartilage degeneration.Findings. The insertion of it polyurethane interpositional spacer in the medial side of the knee did not affect knee kinematics as compared to the normal knee, but caused an increase of articular cartilage cumulative contact stress exposures in the medial compartment of the joint. The knee implanted with the Co-Cr spacer exhibited similar trends in knee kinematics, however significantly different ranges of motion were observed during some periods of the activity cycles, specifically during the first half of the walking cycle where lower ranges of motion were predicted. In addition. higher articular cartilage cumulative contact stress exposures were observed in both compartments of the knee. In both cases, cumulative contact stress exposures of the tibial articular cartilage were more affected than those of the femoral articular cartilage.Interpretation. These results suggest implant material its all important parameter in the design phase of interpositional spacers. (C) 2008 Elsevier Ltd. All rights reserved.