Effect of Suboptimal Neuromuscular Control on the Risk of Massive Wear in Total Knee Replacement

Marco Viceconti,Giorgio Davico,Francesca Bottin,Cristina Curreli

doi:10.1007/s10439-021-02795-y

Marco Viceconti, Giorgio Davico + Show 2 more

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https://doi.org/10.1007/s10439-021-02795-y

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Abstract

The 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.

Highlights

A number of experimental evidences support the theory that normal healthy adults perform stereotypical, sub-maximal tasks by selecting the neuromuscular control pattern that minimises the consumption of metabolic energy.3 Such neuromuscular control strategy is sometime referred to as optimal control
Our recent study showed for the knee replacement patient examined in the Sixth Knee Grand Challenge,4 an uncontrolled manifold of 10% of the maximal muscle activation was required to account for the neuromuscular control variability observed across multiple gait cycles, which produces a variability on the resultant of the forces transmitted through the total knee replacement (TKR) in the order of two body weights (BW) or more
The aim of this work is to explore how a suboptimal neuromuscular control strategy may increase the articular wear in a metal-onpolyethylene total knee replacement, with respect to that we can expect in case of optimal control

Summary

Introduction

A number of experimental evidences support the theory that normal healthy adults perform stereotypical, sub-maximal tasks by selecting the neuromuscular control pattern that minimises the consumption of metabolic energy. Such neuromuscular control strategy is sometime referred to as optimal control. A number of experimental evidences support the theory that normal healthy adults perform stereotypical, sub-maximal tasks by selecting the neuromuscular control pattern that minimises the consumption of metabolic energy.. A number of experimental evidences support the theory that normal healthy adults perform stereotypical, sub-maximal tasks by selecting the neuromuscular control pattern that minimises the consumption of metabolic energy.3 Such neuromuscular control strategy is sometime referred to as optimal control. Our recent study showed for the knee replacement patient examined in the Sixth Knee Grand Challenge, an uncontrolled manifold of 10% of the maximal muscle activation was required to account for the neuromuscular control variability observed across multiple gait cycles, which produces a variability on the resultant of the forces transmitted through the total knee replacement (TKR) in the order of two BW or more. The neuromuscular control one chooses to produce the same kinematics does affect the intensity of forces transmitted through the articular joints; forces transmitted at the knee can be reduced by 2 body weights (BW), depending on the neuromuscular control strategy adopted. Our recent study showed for the knee replacement patient examined in the Sixth Knee Grand Challenge, an uncontrolled manifold of 10% of the maximal muscle activation was required to account for the neuromuscular control variability observed across multiple gait cycles, which produces a variability on the resultant of the forces transmitted through the total knee replacement (TKR) in the order of two BW or more.

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