Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation.
Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation.
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DOI：
10.1016/j.jbiomech.2021.110367
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发表时间：
2021-05-07
影响因子：
2.4
通讯作者：
Imhauser CW
中科院分区：
文献类型：
--
作者：
Elmasry SS;Chalmers BP;Kahlenberg CA;Mayman DJ;Wright TM;Westrich GH;Cross MB;Sculco PK;Imhauser CW
术前屈曲痉挛是初次全膝关节置换术(TKA)术后患者不满的危险因素。先前利用外科导航技术和身体模型的研究试图确定矫正屈膝痉挛的手术技术，并将膝关节不稳定等不良后果降至最低。然而，对于治疗这种临床疾病的手术策略还没有达成共识。因此，本研究的目的是开发和评估屈曲痉挛的全膝关节置换术的计算模型，该模型可用于设计恢复膝关节伸展的手术策略，并了解导致负面结果的因素。利用测量切除技术，我们建立了六种膝关节植入后稳定型全膝关节置换术的计算模型。我们利用身体实验中的参考数据，在膝关节侧副韧带中加入了代表TKA所取得的张力，并通过模拟被动伸展检查来确定屈膝痉挛患者后囊成分中的张力。受试者特定的伸展力矩被计算并用于评估在逐渐切除股骨远端后将恢复的膝关节伸展的量。对股骨远端切除2 mm和4 mm后伸展角度的模型预测分别在先前研究的1.2°(p≥0.32)和1.6°(p≥0.25)之内。因此，本文提出的计算方法可作为研究屈曲肌挛缩对TKA的力学影响和评价其手术治疗的可靠替代方法。
Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.
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