Implant/Construct Interactions in the Biomechanics of Total Hip Dislocation

全髋关节脱位生物力学中植入物/结构的相互作用

• 批准号: 7292738
• 负责人: THOMAS DUDLEY BROWN
• 金额: $ 28.38万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-25 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7292738
• 关键词: Address; Anatomy; Area; Arthroplasty; Articular Range of Motion; Atrophic; Attention; Awareness; Behavior; Biomechanics; Cadaver; Classification; Clinical; Competence; Complement; Complex; Complication; Computer Simulation; Condition; Confounding Factors (Epidemiology); Defect; Drug Formulations; Elements; Event; Evolution; Failure; Finite Element Analysis; Goals; Head; Hip Dislocation; Hip Joint; Hip region structure; Implant; Implantation procedure; Incidence; Individual; Internal Capsule; Investigation; Joint Capsule; Joint Dislocation; Kinetics; Laboratories; Mechanics; Modeling; Morbidity - disease rate; Motion; Nature; Neck; Operative Surgical Procedures; Osteolytic; Patients; Pelvis; Performance; Personal Satisfaction; Placement; Polyethylene; Polyethylenes; Positioning Attribute; Predisposing Factor; Preparation; Procedures; Process; Property; Protocols documentation; Psychological reinforcement; Purpose; Range; Range of motion exercise; Rate; Registries; Relative (related person); Research; Resistance; SAS; Site; Source; Standards of Weights and Measures; Structure; Surface; Surgeon; Surgical incisions; System; Techniques; Testing; Thick; Validation; Variant; Work; capsule; computer studies; design; human subject; implantation; improved; interest; kinematics; novel; repaired; research study; size; soft tissue; tool

DESCRIPTION (provided by applicant): Dislocation remains second only to aseptic loosing as a leading cause of failure in total hip arthroplasty (THA). To complement the limited capabilities for mechanistic investigation afforded by clinical registries or by laboratory experimental studies, an anatomically and kinetically realistic three-dimensional nonlinear finite element (FE) model of THA dislocation has been developed. The formulation builds on substantial previous FE work, to now also include implant interaction(s) with the surrounding anatomic bony surfaces and with the hip joint capsule. The pre-processing sequence is structured for efficient parametric variation of individual implant design parameters and of surgical positioning of the components. The capsule is materially represented in terms of a heterogeneous hyperelastic continuum sheath whose anatomy and mechanical properties are taken from earlier cadaver testing. Input kinematic and kinetic sequences are taken from earlier motion studies of (non-THA-implanted) subjects performing dislocation-prone challenge maneuvers. Corroborative pilot work experimentally with a servo-hydraulic loading system and a novel trans-pelvic THA implantation protocol has reproduced the computations in terms of impingement/dislocation behavior, including capsule compromise effects, of comparable quantitative magnitude. Pilot work computationally has shown that the stable range of motion and the moment developed to resist dislocation depend strongly upon (1) the overall degree of capsule mechanical degradation, (2) focal defects either of internal capsule substance continuity (e.g., incisions) or of external attachment integrity (e.g., detachment from bony insertions), and (3) technical specifics of surgical repair. Four hypotheses, with corresponding specific aims, are structured as an analytical framework for parametric study of the interactions between capsular integrity, dislocation motion challenge, implant design, and component surgical placement. Relevance: THA dislocation rates vary by about an order of magnitude (approximately 1% to 10%), depending on surgical approach, implant design, component placement/orientation, and mechanical competence of the capsule. The problem is particularly vexing for revision surgery (" 8% incidence), a growing proportion of many surgeons' practices and in which capsule compromise is commonplace. Surgeon awareness and interest in this area has increased greatly in recent years, with various capsule repair/reinforcement procedures showing promise, and with many new options arising in terms of implant design and control of component placement. Realistic finite element analysis is an ideal vehicle for systematically assessing the complex interactions of the many factors influencing dislocation propensity, toward the goal of reducing this troublesome complication.

描述(申请人提供)：脱位仍然是仅次于无菌性松动的全髋关节置换术(THA)失败的主要原因。为了补充临床注册或实验室实验研究所提供的有限的机制研究能力，建立了一个解剖和运动学上逼真的全髋关节脱位的三维非线性有限元模型。该配方建立在之前大量有限元工作的基础上，现在还包括植入物与周围解剖骨面和髋关节囊的相互作用(S)。针对单个植入物设计参数和部件的外科定位的有效参数变化，构造了前处理序列。胶囊实质上表现为一种异质的超弹性连续鞘，其解剖和力学特性取自早期的身体测试。输入运动学和运动学序列取自(未植入人工全髋关节的)受试者进行易脱位挑战动作的早期运动研究。使用伺服液压加载系统和一种新的经盆腔全髋关节置入术的实验验证试点工作，在撞击/脱位行为方面重现了计算，包括胶囊妥协效应，具有相当的量化量级。试验性工作的计算表明，稳定的活动范围和产生的抵抗脱位的力矩强烈依赖于(1)囊膜机械退化的总体程度，(2)内部囊膜物质连续性(例如，切口)或外部附着完整性(例如，从骨附着物上脱落)的局灶性缺陷，以及(3)手术修复的技术细节。四个具有相应特定目标的假设被构建为一个分析框架，用于参数研究包膜完整性、脱位运动挑战、植入物设计和假体手术放置之间的相互作用。相关性：全髋关节脱位率大约有一个数量级的差异(大约1%到10%)，这取决于手术入路、植入设计、假体的放置/取向以及关节囊的机械能力。这个问题对于翻修手术(8%的发生率)来说尤其令人烦恼，在许多外科医生的实践中，囊膜受损的比例越来越高。近年来，外科医生对这一领域的认识和兴趣大大增加，各种囊膜修复/加固程序显示出希望，在植入物设计和控制假体放置方面出现了许多新的选择。现实的有限元分析是系统评估影响脱位倾向的许多因素的复杂相互作用的理想工具，旨在减少这一令人烦恼的并发症。