Computational Biomechanics Lab, University of Denver, 2390 S. York Street, Denver, Colorado 80208, USA.
J Orthop Res. 2012 Dec;30(12):2015-24. doi: 10.1002/jor.22169. Epub 2012 Jun 13.
Substantial variation in total knee replacement (TKR) outcomes exists within the patient population. Some of this variability is due to differences in the design of the implanted components and variation in surgical alignment, while other variability is due to differences in the applied forces and torques due to anatomic and physiological differences within a patient population. We evaluated the relative contributions of implant design, surgical alignment, and patient-specific loading variability to overall tibiofemoral joint mechanics to provide insight into which measures can be influenced through design and surgical decisions, and which are inherently dependent on variation within the patient population and should be considered in the robustness of the implant design and surgical procedure. Design, surgical, and loading parameters were assessed using probabilistic finite element methods during simulated stance-phase gait and squat activities. Patient-specific loading was found to be the primary contributor to joint loading and kinematics during low flexion, particularly under conditions of high external loads (for instance, the gait cycle with high internal-external torque), while design and surgical factors, particularly femoral posterior radius and posterior slope of the tibial insert became increasingly important in TKR performance in deeper flexion.
在全膝关节置换（TKR）患者中，存在着大量的置换效果差异。这种变异性部分归因于植入物组件设计的差异和手术对线的变化，而其他变异性则归因于由于患者群体内在解剖和生理差异而导致的应用力和扭矩的差异。我们评估了植入物设计、手术对线和患者特定加载变异性对整个胫股关节力学的相对贡献，以深入了解哪些措施可以通过设计和手术决策来影响，而哪些措施则固有地依赖于患者群体的变异性，并且应该在植入物设计和手术过程的稳健性中加以考虑。在模拟站立相步态和深蹲活动期间，使用概率有限元方法评估设计、手术和加载参数。发现患者特定的加载是在低屈曲时关节加载和运动学的主要贡献者，尤其是在高外部负载（例如，具有高内外扭矩的步态周期）的情况下，而设计和手术因素，特别是股骨后半径和胫骨插入物的后斜率，在更深的屈曲时对 TKR 性能变得越来越重要。
