Multiobjective Design Optimization of Reverse Total Shoulder Arthroplasty

 描述(申请人提供)：反向全肩关节置换术(RTSA)恢复了活动范围，主要为肩袖撕裂关节病患者提供疼痛缓解。这一手术的成功促使更多的人使用其他肩关节疾病，包括骨折、类风湿性关节炎和抢救以前失败的关节置换。事实上，RTSA正在超过美国每年进行的传统肩关节置换手术的数量。然而，RTSA的并发症发生率更高，这可能会限制更广泛的应用。这些并发症通常与稳定性、活动范围、肌肉效率、结果可靠性和耐久性有关。尽管之前有几项实验和计算研究，但最佳的RTSA植入物形状还没有确定，这些潜在的竞争性能指标之间的关系也没有被量化。我们假设RTSA性能指标之间存在相互竞争的关系，并且可以使用经过验证的计算机模型和称为多目标优化(MOO)的严格而系统的设计技术来量化权衡。我们的目标是通过一系列三个特定的目标，每个目标都针对其中的两到三个性能指标，来研究ROM、稳定性、肌肉效率、结果可靠性和种植体耐久性之间的复杂关系。将使用帕累托曲线和曲面来解释相互竞争的绩效指标之间的关系，这将准确地显示在一个绩效指标中需要多大的牺牲才能在另一个绩效指标中有所改进。还将通过使用统计形状模型来考虑特定性别的RTSA植入物设计的必要性，以及患者与患者和手术差异导致的不确定性的影响。由此产生的植入物设计将更加坚固，并与描述多种性能指标之间关系的帕累托曲线和曲面一起，将允许外科医生提供更多针对患者的护理和改善的临床结果。

 DESCRIPTION (provided by applicant): Reverse total shoulder arthroplasty (rTSA) restores range of motion and provides pain relief primarily for patients suffering from cuff tear arthropathy. The success of this procedure has prompted increased usage for other shoulder joint conditions, including fracture, rheumatoid arthritis and salvage of previous failed joint replacements. In fact, rTSA is on pace to exceed the number of conventional shoulder replacements performed annually in the U.S. However, the complication rate of rTSA is higher which may limit more widespread use. These complications often relate to stability, range of motion (ROM), muscle efficiency, outcome reliability and durability. Despite several previous experimental and computational studies, the optimal rTSA implant shape has not been determined, and the relationships between these potentially competing performance measures have not been quantified. We hypothesize that competing relationships exist between rTSA performance measures, and that the trade-offs can be quantified using validated computer models and a rigorous and systematic design technique called Multiobjective Optimization (MOO). Our objective is to investigate the complex relationships between ROM, stability, muscle efficiency, outcome reliability, and implant durability through a series of three specific aims, each targeting two or three of these performance metrics. The relationships between competing performance measures will be explained using Pareto curves and surfaces, which will show exactly how much sacrifice is required in one performance measure in order to improve in another. The need for gender-specific rTSA implant designs, and the effects of uncertainty resulting from patient-to-patient and surgical variability will also be considered through the use of statistical shape models. The resulting implant designs will be more robust and, along with the Pareto curves and surfaces describing the relationship between the multiple performance metrics, will permit surgeons to provide more patient-specific care and improved clinical outcomes.