Koh Yong-Gon, Jung Kyung-Hwan, Hong Hyoung-Taek, Kim Kang-Min, Kang Kyoung-Tak
Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea.
Additive Manufacturing Process R&D Group, Korea Institute of Industrial Technology, Gangneung 25440, Korea.
J Clin Med. 2019 Nov 19;8(11):2023. doi: 10.3390/jcm8112023.
Life expectancy is on the rise and, concurrently, the demand for total knee arthroplasty (TKA), which lasts a lifetime, is increasing. To meet this demand, improved TKA designs have been introduced. Recent advances in radiography and manufacturing techniques have enabled the production of patient-specific TKA. Nevertheless, concerns regarding the wear performance, which limit the lifespan of TKA, remain to be addressed. This study aims at reducing the wear in patient-specific TKA using design optimization and parametric three-dimensional (3D) finite-element (FE) modelling. The femoral component design was implemented in a patient-specific manner, whereas the tibial insert conformity remained to be determined by design variables. The gait cycle loading condition was applied, and the optimized model was validated by the results obtained from the experimental wear tests. The wear predictions were iterated for five million gait cycles using the computational model with force-controlled input. Similar patterns for internal/external rotation and anterior/posterior translation were observed in both initial and optimal models. The wear rates for initial and optimal models were recorded as 23.2 mm/million cycles and 16.7 mm/million cycles, respectively. Moreover, the experimental wear rate in the optimal design was 17.8 mm/million cycles, which validated our optimization procedure. This study suggests that tibial insert conformity is an important factor in influencing the wear performance of patient-specific TKA, and it is capable of providing improved clinical results through enhanced design selections. This finding can boost the future development of patient-specific TKA, and it can be extended to other joint-replacement designs. However, further research is required to explore the potential clinical benefits of the improved wear performance demonstrated in this study.
预期寿命在不断提高，与此同时，对使用寿命为终身的全膝关节置换术（TKA）的需求也在增加。为满足这一需求，已推出改进的TKA设计。放射成像和制造技术的最新进展使得定制TKA的生产成为可能。然而，关于磨损性能的问题仍然有待解决，因为磨损会限制TKA的使用寿命。本研究旨在通过设计优化和参数化三维（3D）有限元（FE）建模来减少定制TKA的磨损。股骨部件设计以定制方式实施，而胫骨插入物的贴合度仍需由设计变量来确定。应用步态周期加载条件，并通过实验磨损测试获得的结果对优化模型进行验证。使用具有力控制输入的计算模型对磨损预测进行了五百万个步态周期的迭代。在初始模型和优化模型中均观察到了相似的内/外旋转和前/后平移模式。初始模型和优化模型的磨损率分别记录为23.2毫米/百万周期和16.7毫米/百万周期。此外，优化设计中的实验磨损率为17.8毫米/百万周期，这验证了我们的优化程序。本研究表明，胫骨插入物的贴合度是影响定制TKA磨损性能的一个重要因素，并且能够通过优化设计选择提供更好的临床效果。这一发现可以推动定制TKA的未来发展，并且可以扩展到其他关节置换设计。然而，需要进一步研究以探索本研究中所展示的改善磨损性能的潜在临床益处。
