RESUMO
Differences in patient anatomy are known to influence joint mechanics. Accordingly, intersubject anatomical variation is an important consideration when assessing the design of joint replacement implants. The objective of this study was to develop a computational workflow to perform population-based evaluations of total knee replacement implant mechanics considering variation in patient anatomy and to assess the potential for an efficient sampling strategy to support design phase screening analyses. The approach generated virtual subject anatomies using a statistical shape model of the knee and performed virtual implantation to size and align the implants. A finite-element analysis simulated a deep knee bend activity and predicted patellofemoral (PF) mechanics. The study predicted bounds of performance for kinematics and contact mechanics and investigated relationships between patient factors and outputs. For example, the patella was less flexed throughout the deep knee bend activity for patients with an alta patellar alignment. The results also showed the PF range of motions in AP and ML were generally larger with increasing femoral component size. Comparison of the 10-90% bounds between sampling strategies agreed reasonably, suggesting that Latin Hypercube sampling can be used for initial screening evaluations and followed up by more intensive Monte Carlo simulation for refined designs. The platform demonstrated a functional workflow to consider variation in joint anatomy to support robust implant design.
Assuntos
Artroplastia do Joelho , Simulação por Computador , Articulação Patelofemoral/fisiopatologia , Algoritmos , Fenômenos Biomecânicos , Feminino , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Modelos Estatísticos , Método de Monte Carlo , Desenho de Prótese , Amplitude de Movimento ArticularRESUMO
BACKGROUND: Bone scintigraphy (BS) is frequently ordered to investigate cause of failure following total knee arthroplasty (TKA). Its correlation of component loosening with intraoperative findings (IFs) at the time of revision TKA (rTKA) has not been well studied. This study investigated correlations between the preoperatively obtained radiologist report (RR) of BS, preoperatively documented surgeon prediction (SP) of component loosening, and operative reports documenting IFs. METHODS: Our institutional database was retrospectively reviewed for all rTKA done after BS and revealed 96 eligible cases. The RR and SP cohorts were subdivided into all potential combinations of component loosening and were then compared with each other as well as IF. In addition to calculating the percentage correct of RR and SP compared with IF, the levels of agreement between RR and SP were compared using the kappa statistic. RESULTS: Of the 96 cases, the RR correctly correlated with IF in 35 cases (37%), whereas the SP was correct in 66 cases (69%), indicating the preoperative interpretation of the surgeon regarding component loosening at rTKA was correct more frequently (P < .001). The kappa statistic between RR and IF was only 0.23 (95% confidence interval [CI] = 0.15-0.32), indicating minimal agreement. The kappa statistic between SP and IF was 0.57 (95% = CI 0.46-0.68), indicating weak agreement. Furthermore, the kappa statistic between RR and SP was 0.36 (95% CI = 0.27-0.45), also indicating minimal agreement. CONCLUSIONS: In rTKA, there is weak agreement regarding component loosening between a radiologist's opinion of a preoperatively obtained bone scan and the surgeon's preoperative interpretation of clinical and radiographic data. While neither reliably accurately predicts what is found at the time of rTKA, the surgeon's preoperative interpretation is more closely correlated with actual IFs of component loosening.
Assuntos
Artroplastia do Joelho/efeitos adversos , Osso e Ossos/diagnóstico por imagem , Prótese do Joelho , Falha de Prótese , Reoperação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , CirurgiõesRESUMO
BACKGROUND: Although the volume of total knee arthroplasties (TKAs) performed in the United States continues to increase, recent reports have shown the percentage of patients who remain "unsatisfied" is as high as 15% to 30%. Recently, several newer implant designs have been developed to potentially improve patient outcomes. QUESTIONS/PURPOSES: The purpose of this study was to determine the impact of high-flex, gender-specific, and rotating-platform TKA designs on patient satisfaction and functional outcomes. METHODS: A four-center study was designed to quantify the degree of residual symptoms and functional deficits in patients undergoing TKA with newer implant designs compared with a 10-year-old, cruciate-retaining (CR) TKA system introduced in 2003. Each contributing surgeon was fellowship-trained and specialized in joint replacement surgery. Only patients younger than 60 years old were included. Data were collected by an independent, third-party survey center blinded to the implant type, who administered questionnaires about patient satisfaction, residual symptoms, function, and pre- and postoperative activity levels using previously published survey instruments. Two hundred thirty-seven CR, 137 rotating-platform, 88 gender-specific, and 65 high-flex TKAs were included in the analysis. Differences in baseline demographic variables were accounted for using multiple logistic regression statistical analyses. RESULTS: Patients who received certain newer designs reported more residual symptoms (grinding, popping, and clicking) in the 30 days before survey administration than the group receiving a 10-year-old CR design (CR, 24% [57 of 237 patients] versus gender-specific, 36% [32 of 88 patients]; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.1-3.8; p=0.03; and rotating-platform, 43% [59 of 137 patients]; OR, 2.2; 95% CI, 1.3-3.7; p<0.001). They also reported more functional problems, including getting in and out of a chair (CR, 19% [46 of 237 patients] versus gender-specific, 37% [32 of 88 patients]; OR, 1.0; 95% CI, 1.1-3.5; p=0.001). Patients with newer TKA designs did not demonstrate any improvements in function or patient satisfaction versus those who received the 10-year-old CR design. CONCLUSIONS: When interviewed by an independent, blinded third party, the use of newer implant designs did not improve patient satisfaction and the presence of residual symptoms when compared with patients who received the 10-year-old CR design. Future studies should prospectively determine whether the purported benefits of newer implant designs improve patient-perceived outcomes. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Assuntos
Artroplastia do Joelho/instrumentação , Articulação do Joelho/cirurgia , Prótese do Joelho , Pacientes/psicologia , Percepção , Desenho de Prótese , Fatores Etários , Artroplastia do Joelho/efeitos adversos , Distribuição de Qui-Quadrado , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Articulação do Joelho/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
Socioeconomic factors may play a role in the development of arthrofibrosis following total knee arthroplasty. Using manipulation following total knee arthroplasty as a surrogate for stiffness, this multicenter case-control study found that African American and young patients (<45 years of age) had twice the odds for manipulation compared with Caucasian and older-age patients.
Assuntos
Artroplastia do Joelho , Articulação do Joelho/fisiopatologia , Amplitude de Movimento Articular , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
This review article evaluates various techniques that have been used to determine in vivo loads in the human knee. Two main techniques that have been used are telemetry, which is an experimental approach, and mathematical modeling, which is a theoretical approach. Telemetric analyses have previously been used to determine the in vivo loading of the human hip and more recently evaluated in the determination of in vivo knee loads. Mathematical modeling approaches can be categorized two ways; those that use optimization techniques to solve an indeterminate system and those that utilize a reduction method that minimizes the number of unknowns, keeping the system solvable as the number of equations of motion are equal to the number of unknown quantities. More recently, we have developed an approach that relies fully on the use of in vivo data from fluoroscopy, CT scanning, magnetic resonant imaging and a revised motion analysis technique that involves only two markers on each rigid body. A review of all techniques revealed a wide range of forces at the human knee, ranging from 1.9 to 7.2 times body weight during level walking.
Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/métodos , Articulação do Joelho/fisiologia , Modelos Biológicos , Exame Físico/métodos , Telemetria/métodos , Suporte de Carga/fisiologia , Animais , Fenômenos Biomecânicos/instrumentação , Fenômenos Biomecânicos/métodos , Fenômenos Biomecânicos/tendências , Simulação por Computador , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Articulação do Joelho/anatomia & histologia , Exame Físico/instrumentação , Exame Físico/tendências , Estresse Mecânico , Avaliação da Tecnologia Biomédica , Telemetria/instrumentação , Telemetria/tendênciasAssuntos
Ligamento Cruzado Anterior/fisiopatologia , Suporte de Carga/fisiologia , Adulto , Ligamento Cruzado Anterior/fisiologia , Fenômenos Biomecânicos , Fêmur/fisiologia , Fêmur/fisiopatologia , Fluoroscopia , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Rotação , Tíbia/fisiologia , Tíbia/fisiopatologia , Tomografia Computadorizada EspiralRESUMO
Formation of a large orthopaedic group practice and practicing within this group carries many risks that are not present in a small group practice. The current authors will discuss the complexity of merging groups, forming corporate policy, hiring executive administrative staff, contracting issues with insurance companies, expanding services and developing ancillary income sources, and the complex interpersonal relationships of a large group practice.