Patient-Specific Modeling of Total Knee Arthroplasty

全膝关节置换术的患者特异性建模

• 批准号: 8337675
• 负责人: Robert Anthony Siston
• 金额: $ 15.09万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-22 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8337675
• 关键词: Activities of Daily Living; Address; Affect; Arthralgia; Back; Cadaver; Computer Simulation; Custom; Data; Degenerative polyarthritis; Devices; Disease; Equilibrium; Freezing; Future Generations; Generic Drugs; Golf; Guidelines; Health; Home environment; Indium; Individual; Joints; Knee; Length; Ligaments; Literature; Love; Measurement; Measures; Mechanics; Methods; Modeling; Motion; Musculoskeletal; Navigation System; Operative Surgical Procedures; Osteoarthrosis Deformans; Outcome; Pain; Passive Range of Motion function; Patients; Play; Postoperative Period; Procedures; Process; Property; Quality of life; Rehabilitation therapy; Series; Simulate; Specimen; Surgeon; Techniques; Tennis; Testing; Time; United States; Work; base; disability; expectation; functional outcomes; functional restoration; improved; insight; kinematics; knee replacement arthroplasty; novel; novel strategies; programs; prosthetic alignment; quadriceps muscle; simulation; soft tissue; success

DESCRIPTION (provided by applicant): The purpose of this work is to develop and validate a process for creating patient-specific simulations of total knee arthroplasty (TKA) with measurements of component alignment and initial soft tissue balance taken at the time of surgery. TKA is a common surgical procedure used to treat degenerative joint diseases such as osteoarthritis. An estimated 500,000 TKAs were performed in the United States in 2006, and approximately 3.48 million annual procedures are expected by the year 2030. While TKA is generally successful at relieving joint pain, some TKA recipients cannot perform basic activities of daily living such as comfortably climbing the stairs in their homes, and many find themselves unable to resume activities they love such as hiking, golfing, or playing tennis. The success of TKA depends on many factors including the pre-operative condition of the knee, alignment of the prosthetic components, management (or "balancing") of soft tissues around the knee, and post-operative rehabilitation. Even though many surgeons have become skilled in developing a qualitative "feel" for knee stability as they manually manipulate the knee during surgery, how the knee "feels" is never documented, and an objective definition as to what constitutes acceptable post-operative stability does not exist. Computer simulations of the knee immediately following TKA have the potential to provide valuable insight into how component alignment and knee stability could affect a patient's ability to perform important functional tasks post-operatively. However, these simulations currently rely on generic descriptions of joints based on measurements made in cadaver specimens, or the simulations are heavily influenced by the properties of the ligaments that surround the knee, which are typically are modeled using archival data from the literature. Since the ligament properties and kinematics in an osteoarthritic knee are different from those of a healthy knee and may remain different following TKA, these assumptions make it impossible to predict the post-operative function of a given patient. Computer simulations which characterize the subject-specific component alignment, kinematics, and ligamentous properties of an individual patient represent an important step toward establishing an objective definition of a "balanced" knee and improving post-operative functional outcomes. This project will develop new patient-specific forward dynamic simulations of TKA. Aim 1 will develop a novel approach for creating patient-specific computer simulations through a series of TKAs on cadaver specimens with the assistance of a surgical navigation system and a custom device that can measure joint stability. We will use these recorded data to develop patient-specific forward dynamic simulations that determine ligament properties through an optimization routine and will explore the effect of ligament lengths, ligament material properties, and number of modeling elements in our optimization. We will then simulate an experimental supine passive range of motion test, the experimental characterizations of knee stability in our custom device, both performed with different trial tibial inserts, and a simulated active knee extension. The success of the approach will be based on the ability of the simulations to match experimentally measured tibiofemoral contact force, knee kinematics, and ligament forces of the same motions. In Aim 2, we will compare the accuracy of the subject-specific simulations developed in Aim 1 against the results of 3 other types of established musculoskeletal modeling techniques that prescribe joint kinematics and/or ligament properties with generic parameters from the literature. The results of the simulated values of knee kinematics, and contact and ligament forces that are generated from the 4 different modeling approaches will be compared against the same values that are recorded experimentally for the tests of passive and simulated active knee extension and the motions in the stability device. This comprehensive and rigorous study creates a process for developing patient-specific simulations of TKA patients based on component alignment and soft tissue balancing. This modeling approach can then be used to objectively parameterize surgical technique, specifically component alignment and initial soft tissue balance, and can be incorporated into future generations of surgical navigation systems to predict post- operative outcome from intra-operative measurements. Data from such patient-specific simulations will provide quantifiable guidelines that will enable surgeons to make better intra-operative decisions, help physical therapists to tailor rehabilitation programs to specific patients, and give patients more realistic expectations for their own specific outcomes.

描述（由申请人提供）：本工作的目的是开发和确认创建全膝关节置换术（TKA）患者特定模拟的过程，并在手术时测量部件对线和初始软组织平衡。TKA是一种常见的外科手术，用于治疗退行性关节疾病，如骨关节炎。据估计，2006年在美国进行了500，000例TKA，预计到2030年，每年约有348万例手术。 虽然TKA通常可以成功缓解关节疼痛，但一些TKA接受者无法进行日常生活的基本活动，例如在家中舒适地爬楼梯，许多人发现自己无法恢复他们喜欢的活动，例如徒步旅行，高尔夫球或打网球。TKA的成功取决于许多因素，包括膝关节的术前状况、假体部件的对线、膝关节周围软组织的管理（或"平衡"）以及术后康复。尽管许多外科医生在手术期间手动操作膝关节时已经熟练地开发膝关节稳定性的定性"感觉"，但从未记录膝关节"感觉"如何，并且不存在关于什么构成可接受的术后稳定性的客观定义。TKA术后膝关节的计算机模拟有可能为了解部件对线和膝关节稳定性如何影响患者术后执行重要功能任务的能力提供有价值的见解。然而，这些模拟目前依赖于基于在尸体标本中进行的测量的关节的通用描述，或者模拟受到围绕膝关节的韧带的性质的严重影响，其通常使用来自文献的存档数据进行建模。由于骨关节炎膝关节的韧带特性和运动学与健康膝关节不同，并且在TKA后可能仍然不同，因此这些假设使得无法预测给定患者的术后功能。计算机模拟表征了个体患者的特定受试者部件对线、运动学和韧带特性，这是建立"平衡"膝关节客观定义和改善术后功能结局的重要一步。 该项目将开发新的TKA患者特定正向动态模拟。目标1将开发一种新方法，通过在手术导航系统和可测量关节稳定性的定制器械的帮助下，在尸体标本上进行一系列TKA，创建患者特定的计算机模拟。我们将使用这些记录的数据来开发患者特定的前向动态模拟，通过优化程序确定韧带特性，并将探索韧带长度、韧带材料特性和优化中建模元素数量的影响。然后，我们将模拟实验性仰卧被动活动度测试、定制器械中膝关节稳定性的实验表征（均使用不同的胫骨垫片试模进行）和模拟主动膝关节伸展。该方法的成功将取决于模拟与相同运动的实验测量胫股接触力、膝关节运动学和韧带力相匹配的能力。在目标2中，我们将比较目标1中开发的受试者特定模拟的准确性与3种其他类型的已建立的肌肉骨骼建模技术的结果，这些技术规定了关节运动学和/或韧带特性，具有文献中的通用参数。将4种不同建模方法生成的膝关节运动学模拟值以及接触力和韧带力的结果与被动和模拟主动膝关节伸展试验以及稳定装置中运动的实验记录的相同值进行比较。 这项全面而严格的研究创建了一个基于组件对线和软组织平衡开发TKA患者特定模拟的过程。然后，该建模方法可用于客观地参数化手术技术，特别是部件对准和初始软组织平衡，并且可被并入未来几代手术导航系统中，以根据术中测量结果预测术后结果。来自这种患者特定模拟的数据将提供可量化的指导方针，使外科医生能够做出更好的术中决策，帮助物理治疗师为特定患者量身定制康复计划，并为患者提供更现实的期望。

项目成果

Estimating patient-specific soft-tissue properties in a TKA knee.

• DOI: 10.1002/jor.23032
• 发表时间: 2016-03
• 期刊: Journal of orthopaedic research : official publication of the Orthopaedic Research Society
• 作者: Ewing JA;Kaufman MK;Hutter EE;Granger JF;Beal MD;Piazza SJ;Siston RA
• 通讯作者: Siston RA