Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement

被引:63
作者
Pegg, Elise C. [1 ]
Walter, Jonathan [2 ]
Mellon, Stephen J. [1 ]
Pandit, Hemant G. [1 ]
Murray, David W. [1 ]
D'Lima, Darryl D. [3 ]
Fregly, Benjamin J. [2 ]
Gill, Harinderjit S. [1 ]
机构
[1] Univ Oxford, Nuffield Dept Orthopaed Rhematol & Musculoskeleta, Nuffield Orthopaed Ctr, Oxford OX3 7LD, England
[2] Univ Florida, Dept Mech & Aerosp Engn, Gainesville, FL USA
[3] Scripps Clin, Shiley Ctr Orthopaed Res & Educ, La Jolla, CA 92037 USA
关键词
finite element; pain; simulation; unicompartmental; knee; MUSCLE FORCES; JOINT; ARTHROPLASTY; PREDICTION; MODEL;
D O I
10.1002/jor.22283
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Persistent pain is an important cause of patient dissatisfaction after unicompartmental knee replacement (UKR) and has been correlated with localized tibial strain. However, the factors that influence these strains are not well understood. To address this issue, we created finite element models to examine the effect on tibial strain of: (1) muscle forces (estimated using instrumented knee data) acting on attachment sites on the proximal tibia, (2) UKR implantation, (3) loading position, and (4) changes in gait pattern. Muscle forces acting on the tibia had no significant influence on strains within the periprosthetic region, but UKR implantation increased strain by 20%. Strain also significantly increased if the region of load application was moved >3mm medially. The strain within the periprosthetic region was found to be dependent on gait pattern and was influenced by both medial and lateral loads, with the medial load having a greater effect (regression coefficients: medial=0.74, lateral=0.30). These findings suggest that tibial strain is increased after UKR and may be a cause of pain. It may be possible to reduce pain through modification of surgical factors or through altered gait patterns. (c) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 821828, 2013
引用
收藏
页码:821 / 828
页数:8
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