Fatigue Damage Evolution in Total Joint Replacements

全关节置换术中的疲劳损伤演变

• 批准号: 7871456
• 负责人: KENNETH A. MANN
• 金额: $ 32.84万
• 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 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7871456
• 关键词: 3-Dimensional; Accounting; Address; Affect; Arthroplasty; Bone Cements; Characteristics; Clinical; Clinical Data; Clinical assessments; Computer Simulation; Development; Elements; Evolution; Failure; Fatigue; Goals; Grant; Hand; Heating; Hip region structure; Immigration; Implant; In Vitro; Individual; Inferior; Mechanics; Modeling; Morphology; Motion; Nature; Operative Surgical Procedures; Outcome; Patients; Polishes; Porosity; Process; Property; Public Health; Relative (related person); Replacement Arthroplasty; Research; Research Personnel; Retrieval; Risk; Role; Simulate; Specimen; Structure; Surface; System; Techniques; Testing; Time; Total Hip Replacement; Vacuum; Work; base; bone; clinically relevant; computerized tools; design; hip replacement arthroplasty; implantation; improved; insight; interfacial; pre-clinical; programs; research study; response; stem; tool

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(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的损伤反应和松动过程的多因素性质的理解的限制。回顾临床数据指出设计、患者和手术因素对松动过程有影响，但往往不能强调失败的机制。种植体在短期内的迁移是临床松动的有力预测指标，这表明在手术时存在导致最终失败的负面因素。在最后一个资助周期中，体外制备的水泥茎结构被证明有助于阐明结构形态与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样品，并集中在界面破坏机制上。这项研究计划的长期目标是实现在患者一生中都能成功发挥作用的关节成形术，而不需要翻修。为此，我们建议开发强大的实验和计算工具，用于初步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/松动响应，(2)结合这些方法来评估疲劳损伤/松动过程对整体演变的相对贡献，(3)验证体外制备的结构的力学响应与身体取回的结构相似，(4)评估临床相关手术对松动过程的作用。构造形态被仔细地量化或控制，因为这被怀疑在机械功能中具有重要作用。总之，我们正在从三个互补的层面解决改善骨水泥型人工髋关节置换术结果的长期目标：通过体外准备和死后取材了解植入系统单个部件的基本机制，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通过开发临床前测试来评估植入部件和外科技术，并确定降低关节置换松动风险的条件，从而改善公众健康。