Proksimal Fibular Osteotomisi ile Kombine Tek Kompartmanlı Diz Artroplastisinin Sonlu Eleman Analizi ile İncelenmesi

Year 2020, Volume: 2 Issue: 2, 121 - 126, 31.12.2020

Nihat Demirhan Demirkıran R. Bugra Husemoglu

Abstract

Konservatif yöntemlerin yanı sıra, medial gonartroz tedavisi için yüksek tibial osteotomi (HTO), unikondiler diz artroplastisi (UKA) ve total diz artroplastisi (TKA) gibi çeşitli cerrahi tedavi yöntemleri uygulanmaktadır. UKA ve PFO'nun birlikte uygulanması, implant üzerindeki yükü ve ardından implant aşınmasını azaltarak daha uzun implant ömrü sağlayabilir. UKA implantı üzerinde fibulektominin uygulanması implant üzerindeki temas stresini azaltıp azaltmayacağını sonlu elemanlar (FE) modeli üzerinde araştırmayı amaçladık.

Çalışmada kullanılmak üzere UKA implantasyonu ve fibula osteotomisinden kaynaklanan biyomekanik ortamdaki değişiklikleri değerlendirmek için Sonlu Elemanlar modeli geliştirildi. Menisküs, kemik ve implantlar lineer elastik izotropik malzeme olarak modellendi. UKA implantı ile 3B diz eklemi modeli oluşturulup bu model üzerinde PFO uygulanmıştır.

Anatomik olarak femur başına 800N luk dikey yük uygulandı. Fibulektomi yapılmadan önce ve sonra tibial komponent üzerindeki stres değerleri değerlendirildi. Temas stresi, UKA için ortalama (10,2 MPa ± 6,8) ve UKA + Fibulektomi için (9,44 MPa ± 6,5) olarak raporlandı.

PFO ve UKA'nın birlikte uygulanması, Sonlu Elemanlar Modelinde implant üzerindeki temas gerilimlerini azaltmıştır. Gözlemlerimizin bulguları ayrıca UKA'nın etkilenen hasta memnuniyetini, tıbbi etkileri ve implant ömrünü artırabilecek ek bir öneri sunmaktadır.

Keywords

unikondiler diz artroplastisi, proksimal fibular osteotomi, sonlu eleman analizi

Finite Element Analysis of Unicondylar Knee Arthroplasty Combined with Proximal Fibular Osteotomy

Abstract

Besides conservative methods, various surgical treatment modalities including high tibial osteotomy (HTO), unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA) have been applied for the treatment of medial gonarthrosis. Combined application of UKA and PFO may enable longer implant survival by reducing the load over the implant and subsequent implant wear. We aimed to investigate on a finite element (FE) model, whether integrating a fibulectomy would reduce the contact stresses on the UKA implant. Finite Elements model developed to evaluate changes in the biomechanical environment resulting from UKA implantation and fibula osteotomy for use in the study. Menisci, bone and implants modeled as linear elastic isotropic material. We developed a 3D knee joint model with UKA implant and performed PFO on this model. A vertical load of 800N was applied anatomically to the femoral head. Stress on the tibial component was assessed before and after fibulectomy was performed. The contact stress was evaluated for UKA the mean stress (10,2 MPa ± 6,8) and for UKA + Fibulectomy (9,44 MPa ± 6,5). Combined application of PFO and UKA reduced contact stresses over the implant on a Finite Element Model. The findings of our observe additionally offer which might also additionally enhance the affected patient satisfaction, medical effects and implant survivorship of UKA.

Keywords

unicondylar knee arthroplasty, proximal fibular osteotomy, finite element analysis

References

• Dillon, C.F., Rasch, E.K., Gu, Q., Hirsch, R., 2006. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol 33, 2271-2279
• Felson, D.T., Lawrence, R.C., Dieppe, P.A., Hirsch, R., Helmick, C.G., Jordan, J.M., Kington, R.S., Lane, N.E., Nevitt, M.C., Zhang, Y., Sowers, M., McAlindon, T., Spector, T.D., Poole, A.R., Yanovski, S.Z., Ateshian, G., Sharma, L., Buckwalter, J.A., Brandt, K.D., Fries, J.F., 2000. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 133, 635-646.
• Dearborn J, Eakin C, Skinner H: Medial compartment arthrosis of the knee. Am J Orthop. 1996, 25:18-26.
• Bartel DL: Unicompartmental arthritis: biomechanics and treatment alternatives . Instr Course Lect. 1992, 41:73.
• Wu L, Hahne HJ, Hassenpflug T: A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis. Chin J Traumatol. 2004, 7:348-353.
• Prakash L: PFO - Proximal Fibular Osteotomy in Medial Compartment Arthritis of the Knee with Varus Deformity. EC Orthopaedics, 2019.
• Yang ZY, Chen W, Li CX, et al.: Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study. Orthopedics. 2015, 38:1110-1114. 10.3928/01477447-20151120-08
• Liu B, Chen W, Zhang Q, Yan X, Zhang F, Dong T, Yang G, Zhang Y. Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis. PLoS One. 2018 May 24;13(5):e0197980.
• Zou G, Lan W, Zeng Y, Xie J, Chen S, Qiu Y. Early clinical effect of proximal fibular osteotomy on knee osteoarthritis. Biomedical Research (2017) Volume 28, Issue 21
• Vaish A, Kathiriya YK, Vaishya R. A critical review of proximal fibular osteotomy for knee osteoarthritis. Archives of Bone and Joint Surgery. 2019 Sep;7(5):453.
• Drager J, Hart A, Abou Khalil J, Zukor DJ, Bergeron SG, Antoniou J. Shorter hospital stay and lower 30-day readmission after unicondylar knee arthroplasty compared to total knee arthroplasty. The Journal of arthroplasty. 2016 Feb 1;31(2):356-61.
• Pandit H, Jenkins C, Barker K, et al. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg (Br). 2006;88:54–60.
• Demirkiran ND, Ozmanevra R. Neutrophil to lymphocyte ratio of patients who underwent bilateral versus unilateral unicompartmental knee arthroplasty. Medicine. 2020;9(1):227-30.
• Chawla H, van der List JP, Christ AB, Sobrero MR, Zuiderbaan HA, Pearle AD. Annual revision rates of partial versus total knee arthroplasty: a comparative meta-analysis. The Knee. 2017 Mar 1;24(2):179-90.
• Kim SJ, Postigo R, Koo S, Kim JH. Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2014 Aug 1;22(8):1895-901.
• Dyrhovden GS, Lygre SH, Badawy M, Gøthesen Ø, Furnes O. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades?. Clinical Orthopaedics and Related Research®. 2017 Jul 1;475(7):1874-86.
• Kwon OR, Kang KT, Son J, Kwon SK, Jo SB, Suh DS, Choi YJ, Kim HJ, Koh YG J Biomechanical comparison of fixed- and mobile-bearing for unicomparmental knee arthroplasty using finite element analysis Orthop Res. 2014 Feb; 32(2):338-45
• A.R. Hopkins, A.M. New, F. Rodriguez-y-Baena, M. Taylor Finite element analysis of unicompartmental knee arthroplasty Med. Eng. Phys., 32 (2010), pp. 14-21
• Kandil A, Werner BC, Gwathmey WF, Browne JA. Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty. The Journal of arthroplasty. 2015 Mar 1;30(3):456-60.
• Kozinn SC, Scott RI. Unicondylar knee arthroplasty. JBJS. 1989 Jan 1;71(1):145-50.
• Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. The Journal of arthroplasty. 2006 Sep 1;21(6):108-15.
• Gulati A, Pandit H, Jenkins C, Chau R, Dodd CA, Murray DW. The effect of leg alignment on the outcome of unicompartmental knee replacement. The Journal of bone and joint surgery. British volume. 2009 Apr;91(4):469-74.
• Nie Y, Ma J, Huang Z, Xu B, Tang S, Shen B, Kraus VB, Pei F. Upper partial fibulectomy improves knee biomechanics and function and decreases knee pain of osteoarthritis: a pilot and biomechanical study. Journal of biomechanics. 2018 Apr 11;71:22-9.
• Pan D, TianYe L, Peng Y, JingLi X, HongZhu L, HeRan Z, QingWen Z, LeiLei C, ZhenQiu C, QiuShi W, Wei H. Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis. Journal of Orthopaedic Surgery and Research. 2020 Dec;15(1):1-0.
• Yazdi H, Mallakzadeh M, Mohtajeb M, Farshidfar SS, Baghery A, Givehchian B. The effect of partial fibulectomy on contact pressure of the knee: a cadaveric study. European Journal of Orthopaedic Surgery & Traumatology. 2014 Oct 1;24(7):1285-9.
• Demirkıran ND. Simultaneous Application of Proximal Fibular Osteotomy and Unicondylar Knee Arthroplasty. Cureus. 2019 May 28;11(5):e4763.