Medical imaging of knee kinematics after joint replacement

人们接受膝关节置换的主要原因是为了减轻他或她因关节炎而引起的疼痛。不幸的是，一些人在手术后仍然有相当大的疼痛，通常是在膝盖区(称为膝前疼痛)。这种疼痛通常归因于股骨(股骨)上的膝盖骨(膝盖骨)轨迹不正确，这是由于不正确的部件设计、不正确的部件放置、过紧的软组织或糟糕的手术技术。目前，大多数外科医生用来“观察”膝盖内部的唯一方法是X光，这是一种单一屈膝角度的二维图像。这些信息不足以研究骨骼的运动。我们建议开发一种新的方法，利用计算机断层扫描(CT)来测量膝关节置换手术后不同屈曲角度下骨骼和假体的三维位置。CT可以生成病人膝盖的3D图像。金属部件在图像上产生条纹，使得准确识别骨骼和部件变得困难，然而我们提出了几种方法来解决这个问题。我们将使用插入身体膝关节标本的参考阵列来验证该协议。然后，我们将该方案应用于患者，以判断最近的植入物设计是否改善了膝盖骨的运动；随后，我们将比较有无疼痛的患者。此外，与CT相反，我们将开发一种用于二维荧光成像的协议，该协议是动态的(即捕获运动的视频)、廉价、可广泛使用并可应用于

The primary reason for someone to get a knee replacement is to reduce his or her pain due to arthritis. Unfortunately, some people still have considerable pain after the surgery, often in the region of the kneecap (called anterior knee pain). Frequently this pain is attributed to incorrect tracking of the kneecap (patella) on the thigh bone (femur) due to improper component design, incorrect placement of the components, excessively tight soft tissues or poor surgical technique. Currently, the only method most surgeons use to 'look inside' the knee is X-rays, which are two-dimensional images at a single angle of knee flexion. These provide inadequate information to study the movements of the bones. We are proposing to develop a new method to measure the three-dimensional positions of both the bones and components after knee replacement surgery at different flexion angles, using computed tomography (CT). CT produces a 3D image of the patient's knees. The metal components create streaks on the image, making it difficult to identify the bones and components accurately, however we are proposing several ways to address this. We will validate the protocol using reference arrays inserted into cadaveric knee specimens. We will then apply the protocol to patients in order to judge whether or not a recent implant design improves kneecap motion; subsequently, we will compare patients with and without pain. In addition, and in contrast, to CT, we will develop a protocol for two-dimensional fluoroscopic imaging, which is dynamic (i.e. captures a video of movement), inexpensive, widely available and could be applied in