基于有限元分析的胫股关节匹配设计对定制单髁膝关节置换术磨损的影响
Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis.
作者信息
Koh Y-G, Park K-M, Lee H-Y, Kang K-T
机构信息
Joint Reconstruction Center, Department of Orthopaedic Surgery, Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea.
Department of Mechanical Engineering, Department of Mechanical Engineering, Yonsei University, Seoul, South Korea.
出版信息
Bone Joint Res. 2019 Apr 2;8(3):156-164. doi: 10.1302/2046-3758.83.BJR-2018-0193.R1. eCollection 2019 Mar.
OBJECTIVES
Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patients. To satisfy this requirement, new patient-specific prosthetic designs have been introduced. The patient-specific UKA is designed on the basis of data from preoperative medical images. In general, knee implant design with increased conformity has been developed to provide lower contact stress and reduced wear on the tibial insert compared with flat knee designs. The different tibiofemoral conformity may provide designers the opportunity to address both wear and kinematic design goals simultaneously. The aim of this study was to evaluate wear prediction with respect to tibiofemoral conformity design in patient-specific UKA under gait loading conditions by using a previously validated computational wear method.
METHODS
Three designs with different conformities were developed with the same femoral component: a flat design normally used in fixed-bearing UKA, a tibia plateau anatomy mimetic (AM) design, and an increased conforming design. We investigated the kinematics, contact stress, contact area, wear rate, and volumetric wear of the three different tibial insert designs.
RESULTS
Conforming increased design showed a lower contact stress and increased contact area. In addition, increased conformity resulted in a reduction of the wear rate and volumetric wear. However, the increased conformity design showed limited kinematics.
CONCLUSION
Our results indicated that increased conformity provided improvements in wear but resulted in limited kinematics. Therefore, increased conformity should be avoided in fixed-bearing patient-specific UKA design. We recommend a flat or plateau AM tibial insert design in patient-specific UKA.: Y-G. Koh, K-M. Park, H-Y. Lee, K-T. Kang. Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis. 2019;8:156-164. DOI: 10.1302/2046-3758.83.BJR-2018-0193.R1.
目的
对于需要治疗单髁骨关节炎的患者，尤其是年轻患者，单髁膝关节置换术（UKA）是全膝关节置换术的一种替代方案。为满足这一需求，已引入了新的个性化假体设计。个性化UKA是根据术前医学图像数据设计的。一般来说，与平膝设计相比，已开发出具有更高贴合度的膝关节植入物设计，以提供更低的接触应力并减少胫骨衬垫的磨损。不同的胫股贴合度可能为设计者提供同时解决磨损和运动学设计目标的机会。本研究的目的是通过使用先前验证的计算磨损方法，在步态加载条件下评估个性化UKA中胫股贴合度设计的磨损预测。
方法
使用相同的股骨部件开发了三种具有不同贴合度的设计：一种通常用于固定平台UKA的平设计、一种胫骨平台解剖模拟（AM）设计和一种增加贴合度的设计。我们研究了三种不同胫骨衬垫设计的运动学、接触应力、接触面积、磨损率和体积磨损。
结果
增加贴合度的设计显示出更低的接触应力和更大的接触面积。此外，贴合度增加导致磨损率和体积磨损降低。然而，增加贴合度的设计显示运动学有限。
结论
我们的结果表明，增加贴合度可改善磨损，但会导致运动学受限。因此，在固定平台个性化UKA设计中应避免增加贴合度。我们建议在个性化UKA中采用平或平台AM胫骨衬垫设计。：Y-G. Koh，K-M. Park，H-Y. Lee，K-T. Kang。使用有限元分析评估胫股一致性设计对个性化单髁膝关节置换术磨损的影响。2019；8：156 - 164。DOI：10.1302/2046 - 3758.83.BJR - 2018 - 0193.R1。
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