Fatigue Damage Evolution in Total Joint Replacements

全关节置换术中的疲劳损伤演变

• 批准号: 7141084
• 负责人: KENNETH A. MANN
• 金额: $ 36.48万
• 依托单位: UPSTATE MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-07-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7141084
• 关键词: arthroplasty; biomaterial development /preparation; biomaterial evaluation; biomaterial interface interaction; biomechanics; hip prosthesis; mechanical stress; medical implant science; medical rehabilitation related tag

DESCRIPTION (provided by applicant): Improving the clinical outcomes of total hip replacement continues to be limited by our understanding of the damage response of the system that causes loosening and the multi-factorial nature of the loosening process. Retrospective clinical data point to design, patient, and surgical factors that have an effect on the loosening process, but are often unable to underscore the failure mechanism. Implant migration in the short-term is a strong predictor of clinical loosening suggesting that there are negative factors built in at the time of surgery that contribute to eventual failure. During this last grant cycle, in vitro prepared cemented stem constructs have proven useful to elucidate some relationships between construct morphology and loosening process, but these experiments were limited to lab-prepared specimens and focused on interfacial failure mechanisms. The long-term goal of this research program is to achieve arthroplasties that function successfully for the lifetime of the patient without need for revision. Towards this end, we propose to develop robust experimental and computational tools that can be used for pre-clinical assessment of cemented total hip replacements after initial implantation. The approach used here is to (1) determine the fatigue damage/loosening response of components of the cemented hip construct, (2) combine these to assess the relative contribution to the overall evolution of the fatigue damage/loosening process, (3) validate that the mechanical response of in vitro prepared structures are comparable to post-mortem retrieved structures and (4) assess the role of clinically relevant surgical procedures on the loosening process. Construct morphology is carefully quantified or controlled as this is suspected as having an important role in mechanical function. In summary, we are addressing the long-term goal of improving outcomes of cemented hip replacements from three complementary levels: understanding the fundamental mechanics of individual components of the implant system using both in vitro prepared and post-mortem retrievals, developing a comprehensive damage model that can be used to assess the short-term outcome of implant systems, and assessing the response of clinically relevant variables. This work will be directly applicable to improving public health through development of pre-clinical tests to assess implant components and surgical techniques and to determine conditions that reduce the risk of loosening of joint replacements.

描述（由申请人提供）：改善全髋关节置换术的临床结果仍然受到我们对导致松动的系统损伤反应的理解和松动过程的多因素性质的限制。回顾性临床数据指出，设计、患者和手术因素对松脱过程有影响，但往往无法强调失败的机制。短期内种植体移位是临床松动的一个强有力的预测指标，这表明在手术时存在导致最终失败的负面因素。在上一个资助周期中，体外制备的骨水泥茎构建体已被证明有助于阐明构建体形态和松动过程之间的一些关系，但这些实验仅限于实验室制备的标本，并专注于界面破坏机制。这项研究计划的长期目标是使关节置换术在患者的一生中都能成功地发挥作用，而不需要翻修。为此，我们建议开发强大的实验和计算工具，可用于首次植入后骨水泥全髋关节置换术的临床前评估。这里使用的方法是：(1)确定骨水泥髋关节结构部件的疲劳损伤/松动反应，(2)将这些因素结合起来评估疲劳损伤/松动过程总体演变的相对贡献，(3)验证体外制备的结构的机械反应与死后取出的结构相当，(4)评估临床相关外科手术对松动过程的作用。构造形态被仔细量化或控制，因为这被怀疑在机械功能中起重要作用。总之，我们正在从三个互补的层面解决改善骨水泥髋关节置换术结果的长期目标：了解使用体外制备和死后回收的植入系统单个组件的基本机制，开发可用于评估植入系统短期结果的综合损伤模型，以及评估临床相关变量的反应。这项工作将直接适用于改善公众健康，通过发展临床前测试来评估植入物组件和手术技术，并确定降低关节置换松动风险的条件。