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Assessment of in vivo gait patterns on wear of total knee replacements.

机译：对全膝关节置换物磨损的体内步态模式进行评估。

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摘要

Lifespan of total knee replacements (TKR) is limited due to wear of the polyethylene tibial liner. Knee load and motion are major factors in TKR wear and are highly activity dependent. Gait is the most frequent activity for TKR patients, however, the effects of walking style (defined as 'gait pattern' by knee kinematics and kinetics) on wear are unknown. Existing testing standards (ISO) for prosthesis evaluation may not be representative of the population mean and do not consider variability. This study investigated the effect of gait pattern on TKR wear.;3D kinematic and kinetic profiles during level walking were obtained for TKR subjects. Analyses were conducted to confirm that individual gait adaptations varied within the population Kinematic and kinetic relationships were investigated to identify gait patterns. Knee wear simulation was conducted using the identified gait patterns, including the profile defined by ISO. Location-specific polyethylene wear was quantified using lanthanide tracers. Wear scar details and damage patterns were also recorded.;Gait was shown to be variable within the population and the testing standards were not kinematically representative of the average TKR patient. Two distinct gait patterns were identified based on the relationship between sagittal translation and the peak external flexion moment. These patterns were classified as high and low motion groups (HMG and LMG). Following wear testing, both in vivo gait patterns had higher wear rates (LMG 14.2+/-7.2 mg/mc; HMG 17.5+/-11.2 mg/mc; ISO 10.0+/-6.4 mg/mc, mean+/-SD), higher percentage of backside-to-total wear (LMG 15.9+/-5.5 %; HMG 19.9+/-2.0 %; ISO 2.8+/-1.6 %), larger percentage of worn-to-total wear areas (LMG 55.7+/-2.5 %; HMG 65.8+/-1.2 %; ISO 42.5+/-2.4 %) and visually more severe frontside and backside tibial damage compared with the standard. Additionally, the HMG showed had higher wear and more severe damage patterns compared with the LMG. The in vivo motion groups produced wear scars similar in size and location to retrievals.;In summary, gait pattern impacted TKR wear. Preclinical evaluation according to ISO underestimates wear occurrence in vivo. The international wear testing standards should be revised to represent realistic kinematics to provide accurate wear assessment for improved rehabilitation therapy and implant design.
机译：由于聚乙烯胫骨衬的磨损，全膝关节置换术（TKR）的使用寿命受到限制。膝盖的负荷和运动是TKR磨损的主要因素，并且高度依赖于活动。步态活动是TKR患者最频繁的活动，但是，步行方式（由膝盖运动学和动力学定义为“步态模式”）对穿着的影响尚不清楚。现有的用于假体评估的测试标准（ISO）可能无法代表总体平均值，也没有考虑变异性。这项研究调查了步态模式对TKR磨损的影响。;获得了TKR受试者水平行走过程中的3D运动学和动力学特征。进行分析以确认个体步态适应在群体内变化运动学和动力学关系被研究以识别步态模式。使用确定的步态模式（包括由ISO定义的轮廓）进行膝盖磨损模拟。使用镧系元素示踪剂定量分析特定位置的聚乙烯磨损。还记录了磨损痕迹的详细信息和损伤方式。步态在人群中被证明是可变的，并且测试标准在运动学上不能代表平均TKR患者。基于矢状平移与峰值外屈曲力矩之间的关系，确定了两种不同的步态模式。这些模式分为高运动组和低运动组（HMG和LMG）。进行磨损测试后，两种体内步态均具有较高的磨损率（LMG 14.2 +/- 7.2 mg / mc； HMG 17.5 +/- 11.2 mg / mc； ISO 10.0 +/- 6.4 mg / mc，平均值+/- SD），背面占总磨损的百分比更高（LMG 15.9 +/- 5.5％; HMG 19.9 +/- 2.0％; ISO 2.8 +/- 1.6％），磨损占总磨损面积的百分比更高（LMG 55.7 + / -2.5％； HMG 65.8 +/- 1.2％； ISO 42.5 +/- 2.4％），并且与标准相比，视觉上对胫骨的正面和背面的损害更为严重。此外，与LMG相比，HMG表现出更高的磨损和更严重的损坏方式。体内运动组产生的磨损疤痕的大小和位置与取回类似。总之，步态模式影响了TKR磨损。根据ISO进行的临床前评估低估了体内的磨损发生率。应修改国际磨损测试标准，以代表现实的运动学，以提供准确的磨损评估，以改善康复治疗和植入物设计。

著录项

  • 作者

    Ngai, Yuen-Ying Valentina.;

  • 作者单位

    University of Illinois at Chicago, Health Sciences Center.;

  • 授予单位 University of Illinois at Chicago, Health Sciences Center.;
  • 学科 Engineering Biomedical.;Health Sciences Recreation.;Biophysics Biomechanics.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 154 p.
  • 总页数 154
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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