Chen Zhenxian, Zhang Zhifeng, Gao Yongchang, Zhang Jing, Guo Lei, Jin Zhongmin
School of Construction Machinery, Chang'an University, Xi'an 710064, P. R. China.
Department of Arthroplasty Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, P. R. China.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2022 Aug 25;39(4):651-659. doi: 10.7507/1001-5515.202203023.
Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.
后稳定型全膝关节假体已广泛应用于膝关节骨关节炎的骨科临床治疗，但患者和外科医生仍受并发症困扰，例如后交叉韧带托严重磨损和断裂以及假体松动。了解膝关节假体的生物力学将有助于减少术后假体翻修和患者的不满。因此，分别使用六种不同设计的后稳定型全膝关节假体建立全膝关节置换术的肌肉骨骼多体动力学模型，并在行走、右转和下蹲三种模拟生理活动下研究六种后稳定型全膝关节假体的生物力学差异。结果表明，PFC Sigma和Scorpio NGR假体在行走、右转和下蹲时后交叉韧带托接触力较大，这可能增加骨折、磨损以及早期松动的风险。Gemini SL假体的后交叉韧带托设计更有利于膝关节内外旋转，并避免边缘接触和磨损。矢状面较低的贴合度设计和后凸轮较晚的啮合导致较大的前后平移。本研究为指导外科医生选择、改进后稳定型假体设计及减少假体失败提供了理论支持。
