Relative contributions of design, alignment, and loading variability in knee replacement mechanics
Relative contributions of design, alignment, and loading variability in knee replacement mechanics
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DOI：
10.1002/jor.22169
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发表时间：
2012-12-01
影响因子：
2.8
通讯作者：
Rullkoetter, Paul J.
中科院分区：
文献类型：
--
作者：
Fitzpatrick, Clare K.;Clary, Chadd W.;Rullkoetter, Paul J.
全膝关节置换术（TKR）结局在患者人群中存在显著差异。其中一些变异性是由于植入部件的设计差异和手术对线的差异，而其他变异性是由于患者人群中解剖和生理差异导致的施加力和扭矩差异。我们评价了植入物设计、手术对线和患者特定载荷变异性对整体胫股关节力学的相对贡献，以了解哪些措施可能受到设计和手术决策的影响，哪些措施本质上取决于患者人群中的变化，并应在植入物设计和手术程序的稳健性中予以考虑。在模拟站立相步态和下蹲活动期间，使用概率有限元方法评估设计、手术和载荷参数。研究发现，患者特定载荷是低屈曲时关节载荷和运动学的主要影响因素，特别是在高外部载荷条件下（例如，具有高内外扭矩的步态周期），而设计和手术因素，特别是股骨后半径和胫骨垫片后倾角，在更深屈曲时的TKR性能中变得越来越重要。(c)2012骨科研究学会。出版社：Wiley Periodicals，Inc.骨科研究杂志30：2015 - 2024，2012
Substantial variation in total knee replacement (TKR) outcomes exists within the patient population. Some of this variability is due to differences in the design of the implanted components and variation in surgical alignment, while other variability is due to differences in the applied forces and torques due to anatomic and physiological differences within a patient population. We evaluated the relative contributions of implant design, surgical alignment, and patient-specific loading variability to overall tibiofemoral joint mechanics to provide insight into which measures can be influenced through design and surgical decisions, and which are inherently dependent on variation within the patient population and should be considered in the robustness of the implant design and surgical procedure. Design, surgical, and loading parameters were assessed using probabilistic finite element methods during simulated stance-phase gait and squat activities. Patient-specific loading was found to be the primary contributor to joint loading and kinematics during low flexion, particularly under conditions of high external loads (for instance, the gait cycle with high internalexternal torque), while design and surgical factors, particularly femoral posterior radius and posterior slope of the tibial insert became increasingly important in TKR performance in deeper flexion. (c) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:20152024, 2012