Research and Development, Zimmer Inc., PO Box 708, Warsaw, IN 46580, USA.
J Biomech. 2013 Sep 27;46(14):2331-41. doi: 10.1016/j.jbiomech.2013.07.027. Epub 2013 Aug 6.
Total elbow arthroplasty is a clinically successful procedure, yet long-term implant survival rates have historically lagged behind those reported for total hips and knees. Clinical complications associated with implant wear, osteolysis, stem loosening and device fracture have been implicated as reasons for limited long-term survivorship. Unfortunately, there is little published information on the biomechanics and method(s) for preclinical evaluation of total elbow prostheses that could provide insight into the mechanisms of failure. Additionally, there are no consensus testing standards or summaries of loading profiles of the humero-ulnar joint associated with a range of activities of daily living. Such data would facilitate the standardized preclinical assessment of total elbow devices such is commonplace for other large joints. The objective of the work here is therefore to provide a comprehensive review of elbow joint biomechanics as it relates to preclinical evaluation of total elbow implants. This summary includes a review of elbow joint forces, kinematics, the types and frequency of humero-ulnar joint motions associated with activities of daily living and clinical outcomes, as well as proposing a methodology for deriving humero-ulnar joint reaction force magnitudes and vector orientations as a function of a known mass/force at the hand. From these data, a scalable, bi-axial loading profile is proposed as a foundation for the development of clinically relevant, laboratory simulations for assessment of total elbow prostheses performance.
全肘关节置换术是一种临床效果成功的手术，但长期以来，植入物的存活率一直落后于全髋关节和膝关节的报告。与植入物磨损、骨溶解、柄松动和器械断裂相关的临床并发症被认为是导致长期存活率有限的原因。不幸的是，关于全肘关节假体的临床前评估的生物力学和方法（s）的信息很少，这些信息可以深入了解失败的机制。此外，没有关于与日常生活中各种活动相关的肱尺关节的加载曲线的共识测试标准或摘要。这样的数据将有助于对全肘设备进行标准化的临床前评估，就像其他大关节一样常见。因此，这里工作的目的是全面回顾与全肘植入物的临床前评估相关的肘关节生物力学。本综述包括对肘关节力、运动学、与日常生活相关的肱尺关节运动的类型和频率以及临床结果的回顾，以及提出一种方法来推导作为已知手部质量/力函数的肱尺关节反作用力大小和矢量方向。从这些数据中，提出了一个可扩展的双轴加载曲线，作为开发临床相关的实验室模拟以评估全肘假体性能的基础。
