RESUMEN
Computational models that predict clinical surface damage of the tibial insert during activities of daily living are emerging as powerful tools to assess the safety and efficacy of contemporary total knee arthroplasty designs. These models have the advantage of quickly determining the performance of new designs at low cost, and they allow direct comparison with the performance of classic, clinically successful designs. This study validated finite element and kinematic modeling predictions through comparison with preclinical physical testing results, damage patterns on retrieved tibial inserts, and clinically measured knee motion. There is a mounting body of evidence to support the role of computational modeling as a preclinical tool that enables the optimization of total knee arthroplasty designs and the auditing of component quality control before large-scale manufacturing is undertaken.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Simulación por Computador , Prótesis de la Rodilla , Modelos Anatómicos , Rango del Movimiento Articular/fisiología , Tibia/cirugía , Artroplastia de Reemplazo de Rodilla/efectos adversos , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Articulación de la Rodilla/cirugía , Valor Predictivo de las Pruebas , Diseño de Prótesis , Falla de Prótesis , Medición de Riesgo , Estrés MecánicoRESUMEN
The continuing global interest in the use of total and unicompartmental mobile-bearing knee designs is manifest by an appreciation of their clinical performance. Like their fixed plateau counterparts, mobile-bearing knees are influenced by patient and surgical variables as well as design, material, and manufacturing choices. This article is a focused description of tibiofemoral surface stress distributions, as a predictor of in vivo material durability for three contemporary designs at positions encountered during daily activity.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla/fisiología , Prótesis de la Rodilla , Soporte de Peso/fisiología , Análisis de Falla de Equipo , Análisis de Elementos Finitos , Humanos , Polietilenos , Diseño de Prótesis , Rango del Movimiento Articular , Estrés Mecánico , Propiedades de Superficie , Caminata/fisiologíaRESUMEN
In June 2004, the U.S. Food and Drug Administration Orthopaedic Advisory Panel recommended the reclassification of mobile-bearing knee systems for general use. This reflects the increasing use of mobile-bearing knee systems internationally, which is currently limited in the United States by regulatory requirement. Mobile-bearing knee systems are distinguished from conventional, fixed-plateau systems in that they allow dual-surface articulation between an ultra-high molecular weight polyethylene insert and metallic femoral and tibial tray components. Their in vivo success is dependent on patient selection, design, and material choice, as well as surgical precision during implantation. Laboratory and clinical experience extending over 25 years with individual systems suggests that mobile-bearing knee systems represent a viable treatment option for patients with knee arthrosis.