The Influence of Component Alignment and Ligament Properties on Tibiofemoral Contact Forces in Total Knee Replacement
The Influence of Component Alignment and Ligament Properties on Tibiofemoral Contact Forces in Total Knee Replacement
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DOI：
10.1115/1.4032464
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发表时间：
2016-02-01
影响因子：
1.7
通讯作者：
Thelen, Darryl G.
中科院分区：
文献类型：
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作者：
Smith, Colin R.;Vignos, Michael F.;Thelen, Darryl G.
研究目的是调查冠状面对线和韧带特性对行走过程中全膝关节置换术（TKR）接触载荷的影响。我们创建了一名83岁男性的受试者专用膝关节模型，该患者接受了内固定TKR。将膝关节模型纳入下肢肌肉骨骼模型，包括可变形接触、韧带结构和六自由度（DOF）胫股和髌股关节。一种新的数值优化技术被用来同时预测肌肉力量，次级膝关节运动学，韧带力，关节接触压力从标准步态分析数据收集的主题。步态期间内侧、外侧和总接触力的标称膝关节模型预测与TKR测量结果一致，均方根（rms）误差分别为0.23、0.22和0.33体重（BW）。冠状面部件对线不影响全膝关节接触载荷，但确实改变了内外侧载荷分布，部件对线中4 °内翻和4 °外翻旋转分别导致内侧胫股接触力第一峰值变化+17%和-23%。Monte Carlo分析表明，韧带刚度和参考应变的不确定性导致步态周期内胫股力估计值的+/- 0.2 BW不确定性。韧带特性对TKR载荷分布有显著影响，内侧副韧带和髂胫束（ITB）特性分别对内侧和外侧间室载荷影响最大。计算框架提供了一种可行的方法，虚拟设计TKR组件，考虑参数的不确定性，并预测关节对准和软组织平衡程序对TKR功能在运动过程中的影响。
The study objective was to investigate the influence of coronal plane alignment and ligament properties on total knee replacement (TKR) contact loads during walking. We created a subject-specific knee model of an 83-year-old male who had an instrumented TKR. The knee model was incorporated into a lower extremity musculoskeletal model and included deformable contact, ligamentous structures, and six degrees-of-freedom (DOF) tibiofemoral and patellofemoral joints. A novel numerical optimization technique was used to simultaneously predict muscle forces, secondary knee kinematics, ligament forces, and joint contact pressures from standard gait analysis data collected on the subject. The nominal knee model predictions of medial, lateral, and total contact forces during gait agreed well with TKR measures, with root-mean-square (rms) errors of 0.23, 0.22, and 0.33 body weight (BW), respectively. Coronal plane component alignment did not affect total knee contact loads, but did alter the medial-lateral load distribution, with 4 deg varus and 4 deg valgus rotations in component alignment inducing +17% and -23% changes in the first peak medial tibiofemoral contact forces, respectively. A Monte Carlo analysis showed that uncertainties in ligament stiffness and reference strains induce +/- 0.2 BW uncertainty in tibiofemoral force estimates over the gait cycle. Ligament properties had substantial influence on the TKR load distributions, with the medial collateral ligament and iliotibial band (ITB) properties having the largest effects on medial and lateral compartment loading, respectively. The computational framework provides a viable approach for virtually designing TKR components, considering parametric uncertainty and predicting the effects of joint alignment and soft tissue balancing procedures on TKR function during movement.