Date of Award
Master of Science (MS)
Kwartowitz , David
Pace , Thomas
Total knee replacement (TKR) is a successful procedure for the relief of pain, correction of deformity, and restoration of function in patients with knee arthritis.1-3 In the United States, the number of primary TKR surgeries performed in 2030 is projected to be between 2,938,000 to 4,136,000 and revision surgeries between 193,000 to 381,000.4 Osteolysis, pain, and aseptic loosening are the most common causes of revision TKR surgery.5 The purpose of this thesis is to complete assessments for post-market surveillance of total knee replacement (TKR) targeting areas for improving polymer bearings through evaluation of clinical outcomes and analysis of prosthesis retrieved after in vivo function. The overall objective of this thesis is to use such assessments for comparing different polyethylene types (conventional and highly cross-linked) and articular designs (cruciate retaining and posterior stabilized) currently in use for TKR. This overall objective is accomplished in three specific aims.
The first aim completes a retrospective clinical outcome study of 9 patients (10 cases), fully describing pre-operative and intra-operative surgical decision models for the clinical evaluation and surgical treatment of TKR patients with focal areas of periprosthetic osteolysis. Patients have not exhibited any further complications associated with osteolysis after 5.1±2.4 years of follow up. Routine radiographic exams show total incorporation of the graft material into the previously lytic regions in all patients.
The second aim acquires polyethylene inserts that have functioned in patients and develops a custom analysis program with a graphical user interface (GUI) for completing quantitative assessments of damage patterns observed on the polyethylene inserts' surfaces. The developed analysis software outputs accurate and reproducible results comparable to ImageJ software. Additionally, the developed GUIs allow for user friendly image digitization, processing and analysis and eliminate of the need for users to have extensive computer programming knowledge.
The third aim uses the image-based measurement tool developed in the second aim to assess damage patterns occurring on the retrieved polyethylene tibial inserts with different types of polyethylene, namely conventional and highly cross-linked ultrahigh molecular weight polyethylene, and on tibial inserts with different types of articular constraint, namely posterior cruciate ligament retaining and posterior stabilized. The results of this aim provide unique insight into the effects of the physiological environment in which the TKR devices performed that simulations have not yet been able to replicate and provide data on the effects of changes to TKR design, including polyethylene types and articular constraints.
Nunez, Leah, "Post-Market Surveillance of Total Knee Replacement Combining Clinical Outcomes and Quantitative Image Processing Techniques" (2013). All Theses. 1665.