Characterizing the trade-off between range of motion and stability of reverse total shoulder arthroplasty.
Characterizing the trade-off between range of motion and stability of reverse total shoulder arthroplasty.
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DOI：
10.1016/j.jse.2021.05.002
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发表时间：
2021-12
影响因子：
3
通讯作者：
Willing R
中科院分区：
文献类型：
--
作者：
Elwell JA;Athwal GS;Willing R
反肩关节置换术(RSA)的活动范围(ROM)和稳定性之间的权衡一直被认为是存在的，但还没有得到很好的描述。这项研究的目的是使用设计优化技术来获得帕累托曲线，它量化了两个相互竞争的目标之间的权衡，并由最优设计的表现来定义，最大限度地提高了一个手术的结果，而不牺牲另一个。采用多目标设计优化技术，同时调整4个设计和手术参数，包括肩袖偏侧度(GLAT)、颈干角(NSA)、旋转中心下偏移量(CORinf)和肱骨偏侧度(HLat)。使用有限元模型、肌肉骨骼模型、解析方程和代理模型的组合，对任何候选设计的ROM值和稳定性(待优化的目标)进行了计算表征。对于标准杯深和浅杯深，分别确定了最佳设计和帕累托曲线。就只读存储器和稳定性而言，最优设计的性能与具有代表性的商业可用设计进行了比较。得到了每个杯子深度的帕累托曲线，证实了在只读存储器和RSA稳定性之间存在权衡。与商业上可用的设计(8.1 mm杯深，GLAT=5 mm，NSA=155°，CORINF=0 mm，HLAT=0 mm)相比，针对只读存储器优化的设计提供了38.8%(杯深=6 mm，GLAT=16 mm，NSA=163.6°，CORINF=4 mm，HLAT=0.6 mm)和35.2%(杯深=8.1 mm，GLAT=16 mm，NSA=160.5°，CORINF=4 mm，HLAT=−0.2 mm)的ROM改善。对稳定性进行了优化的设计(杯深=6 mm，GLAT=16 mm，NSA=170°，CORinf=4 mm，HLat=3 mm；杯深=8.1 mm，GLAT=16 mm，NSA=170°，CORinf=4 mm，HLat=3 mm)都比商用设计提高了12.4%。在帕累托曲线的脚趾区域的设计提供了比这两个目标的商业可用设计最大可能改进的75%-90%。已经证实，在只读存储器和RSA的稳定性之间存在权衡，最大化一个结果需要牺牲另一个结果。在遍历帕累托前线时，在相互竞争的结果中的相对收益和牺牲可能有助于理解基于患者特定需求的临床最佳设计。基础科学研究；计算机建模
The trade-off between range of motion (ROM) and stability of reverse shoulder arthroplasty (RSA) has long been hypothesized to exist, but has not yet been well-characterized. The goal of this study was to use design optimization techniques to obtain a Pareto curve, which quantifies the trade-off between two competing objectives, and is defined by the performance of optimum designs which maximize one surgical outcome without sacrificing the other. Multi-objective design optimization techniques were employed; four design and surgical parameters including glenoid lateralization (GLat), neck-shaft angle (NSA), inferior offset of the center of rotation (CORinf) and humerus lateralization (HLat) were tuned simultaneously. The ROM and stability, the objectives to be optimized, of any candidate design were characterized computationally using a combination of finite element models, musculoskeletal models, analytic equations, and surrogate models. Optimum designs and Pareto curves were determined separately for a standard and shallow cup depth. The performance of the optimum designs, in terms of ROM and stability was, compared to a representative commercially available design. A Pareto curve was obtained for each cup depth, confirming there is a trade-off between ROM and stability of RSA. In comparison to the commercially available design (8.1 mm cup depth, GLat = 5 mm, NSA = 155°, CORinf = 0 mm and HLat = 0 mm), the designs optimized for ROM offered 38.8% (cup depth = 6 mm, GLat = 16 mm, NSA = 163.6°, CORinf = 4 mm, HLat = 0.6 mm) and 35.2% (cup depth = 8.1 mm, GLat = 16 mm, NSA = 160.5°, CORinf = 4 mm, HLat = −0.2 mm) improvement in ROM. The designs optimized for stability (cup depth = 6 mm, GLat = 16 mm, NSA = 170°, CORinf = 4 mm, HLat = 3 mm; cup depth = 8.1 mm, GLat = 16 mm, NSA = 170°, CORinf = 4 mm, HLat = 3 mm) both offered 12.4% improvement in stability over the commercially available design. Designs in the toe region of the Pareto curve offered between 75-90% of the maximum possible improvement over the commercially available design for both objectives. It was confirmed that a trade-off exists between ROM and stability of RSA, where maximizing one outcome requires a sacrifice in the other. The relative gains and sacrifices in the competing outcomes when traversing the Pareto front could aid in understanding clinically optimum designs based on patient-specific needs. Basic Science Study; Computer Modeling
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影响因子：
3
作者：
Schairer, William W.;Nwachukwu, Benedict U.;Gulotta, Lawrence V.
通讯作者：
Gulotta, Lawrence V.
DOI：
10.1115/1.4006115
发表时间：
2012-03-01
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作者：
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DOI：
10.1177/0954411917735129
发表时间：
2017-12-01
影响因子：
1.8
作者：
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通讯作者：
Gupta, Dheeraj
影响因子：
3
作者：
Hoenecke, Heinz R., Jr.;Flores-Hernandez, Cesar;D'Lima, Darryl D.
通讯作者：
D'Lima, Darryl D.