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Biomechanical Effects of different Design and Features on Knee Arthroplasties Performances

par Bori, Edoardo
Président du jury Delchambre, Alain
Promoteur Innocenti, Bernardo
Publication Non publié, 2023-04-24

Thèse de doctorat

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Résumé :

To comprehensively assess the functionality of the knee joint in patients, the principal parameter that is usually evaluated are the joint performances: these latter are a combination of biomechanical outcomes and patient satisfaction, and both factors are important as they play a crucial role in determining the final outcome.The occurrence of pathologies and the aging process lead to divergences of knee joint performances from the physiological optimal ones. The main aim of knee arthroplasties, therefore, is to restore such performances by replacing the defective components with artificial ones; to achieve this goal, it is crucial to determine the optimal physiological performances and thus establish the criteria for restoration. It is then fundamental to identify the expected outcomes of the different combinations available for the surgeon to choose among, in order then to select the one that best fits with the sought performances; these outcomes are depending on the combination of different factors related respectively to the patient (in terms of bone geometry, presence of eventual deformities and soft tissue situation), to the implant chosen (that can be chosen, as addressed in Chapter 1, according to the compartments involved, the level of constraint sought and eventual additional features) and to the surgical approaches and tool used (data accuracy, cut definition, cut performance, fixation technique).Every step made increasing the current knowledge on the relations among these parameters and their relative consequences on the joint performances, then, contribute to the definition of more and more comprehensive Surgical Guidelines to assist the surgeons in their choices; relying on this information, indeed, the surgeon could determine with more certainty which implant configuration represented the most optimal solution for the specific patient addressed, evaluated both accounting for the patient’s biomechanics and expectations from the implant. In order to accomplish this objective and define the mentioned guidelines, it is essential to incorporate various research methodologies, including clinical, experimental, and in-silico tests. This interdisciplinary approach is necessary to effectively address the nature of this research topic, which demands the contribution of experts from diverse fields to explore a wide range of scenarios and acquire data that cannot be obtained through a singular method.The present PhD thesis is therefore the result of a collaborative effort between the engineering and surgical worlds, both in terms of subject matters and in terms of individuals involved throughout its various phases: the research performed aimed therefore to both provide critical insights to assist in the development of the mentioned comprehensive guidelines and to answer the clinical questions raised by the members of the medical community involved in these studies.