Abstract
AbstractThe optimal neuromuscular control (muscle activation strategy that minimises the consumption of metabolic energy) during level walking is very close to that which minimises the force transmitted through the joints of the lower limbs. Thus, any suboptimal control involves an overloading of the joints. Some total knee replacement patients adopt suboptimal control strategies during level walking; this is particularly true for patients with co-morbidities that cause neuromotor control degeneration, such as Parkinson’s Disease (PD). The increase of joint loading increases the risk of implant failure, as reported in one study in PD patients (5.44% of failures at 9 years follow-up). One failure mode that is directly affected by joint loading is massive wear of the prosthetic articular surface. In this study we used a validated patient-specific biomechanical model to estimate how a severely suboptimal control could increase the wear rate of total knee replacements. Whereas autopsy-retrieved implants from non-PD patients typically show average polyethylene wear of 17 mm3 per year, our simulations suggested that a severely suboptimal control could cause a wear rate as high as of 69 mm3 per year. Assuming the risk of implant failure due to massive wear increase linearly with the wear rate, a severely suboptimal control could increase the risk associated to that failure mode from 0.1% to 0.5%. Based on these results, such increase would not be not sufficient to justify alone the higher incidence rate of revision in patients affected by Parkinson’s Disease, suggesting that other failure modes may be involved.
Funder
H2020 Societal Challenges
Horizon 2020 Framework Programme
Alma Mater Studiorum - Università di Bologna
Publisher
Springer Science and Business Media LLC
Reference16 articles.
1. Baek, J.-H., C. H. Nam, S. C. Lee, H. S. Ahn, and Y.-C. Ha. Poor outcomes of primary total knee arthroplasty in patients with Parkinson’s disease. Int Orthopaed 45:643–647, 2021.
2. Bordini, B., S. Stea, S. Falcioni, C. Ancarani, and A. Toni. Unicompartmental knee arthroplasty: 11-year experience from 3929 implants in RIPO register. Knee 21:1275–1279, 2014.
3. Crowninshield, R. D. A physiologically based criterion for muscle force predictions on locomotion. Bull Hosp Jt Dis Orthop Inst 43:164–170, 1983.
4. Fregly, B. J., T. F. Besier, D. G. Lloyd, S. L. Delp, S. A. Banks, M. G. Pandy, and D. D. D’Lima. Grand challenge competition to predict in vivo knee loads. J Orthop Res 30:503–513, 2012.
5. Fuchs, S., L. Thorwesten, and S. Niewerth. Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 78:39–45, 1999.
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