Intra-articular Pressure Measurement of the Tibiofemoral Knee Joint

Stijn Herregodts
Intra-articulaire Drukmeting van het Tibiofemorale KniegewrichtHet aantal operaties waarbij een totale knieprothese wordt geplaatst, stijgt jaarlijks. Ondanks het feit dat deze chirurgische ingreep de levenskwaliteit van de meeste patiënten verbetert, blijft een significant aantal patiënten toch ontevreden. Oorzaken voor deze ontevredenheid zijn onder andere blijvende kniepijn en een slechte stabiliteit van het kniegewricht. De positionering van de prothese wordt aanzien als de sleutelfactor om de volledige kniefunctie te herstellen en patiënttevredenheid op lange termijn te garanderen. 1.

Intra-articular Pressure Measurement of the Tibiofemoral Knee Joint

Intra-articulaire Drukmeting van het Tibiofemorale Kniegewricht

Het aantal operaties waarbij een totale knieprothese wordt geplaatst, stijgt jaarlijks. Ondanks het feit dat deze chirurgische ingreep de levenskwaliteit van de meeste patiënten verbetert, blijft een significant aantal patiënten toch ontevreden. Oorzaken voor deze ontevredenheid zijn onder andere blijvende kniepijn en een slechte stabiliteit van het kniegewricht. De positionering van de prothese wordt aanzien als de sleutelfactor om de volledige kniefunctie te herstellen en patiënttevredenheid op lange termijn te garanderen.

1. Stand van zaken

De huidige kennis over de invloed van een totale knievervanging op de kniekinematica en -kinetica is nog steeds beperkt. Toch is die kennis essentieel om de positionering van protheses te kunnen optimaliseren. Om de hiaat te vullen, zijn in-vitrotesten de aangewezen onderzoeksmethode. In zulke testen wordt de totale knievervanging uitgevoerd op een kadaver. De in-vitrotesten bieden de mogelijkheid om de kinematica en kinetica van de knie zowel voor als na de operatie grondig te bestuderen en beide situaties te vergelijken. Om de complexe werking van het kniegewricht goed te kunnen begrijpen, is het van cruciaal belang om een betrouwbaar beeld te bekomen van de contactdrukverdeling in het gewricht. Een meettechniek die wereldwijd vaak wordt toegepast voor dit soort onderzoek, is een contactdrukmeting met behulp van een drukgevoelige meetfilm van het merk Tekscan. Niettegenstaande het wijdverspreide gebruik van deze meettechniek zijn de nauwkeurigheid en betrouwbaarheid van de meetresultaten tot op heden eerder beperkt. De voornaamste oorzaak voor de weinig bevredigende meetresultaten is, dat de complexiteit van de sensoreigenschappen nog niet ontrafeld is. Ondanks herhaaldelijke pogingen om de nauwkeurigheid van de sensor te valideren, zijn studies die deze materie op een kritische en fundamentele manier benaderen zeer schaars.

2. Onderzoeksproject

2.1. Ontwikkeling proefmachine

In dit project worden voor het eerst alle sensoreigenschappen die een effect hebben op de meetnauwkeurigheid grondig onderzocht. Om dit onderzoek mogelijk te kunnen maken, diende er eerst een speciale meerassige proefstand ontwikkeld en gebouwd  te worden (Figuur 1). De modulaire opbouw van de proefmachine maakt het mogelijk om een grote diversiteit aan proeven uit te voeren op dezelfde machine. De proefstand waarin verschillende sensoren zijn geïntegreerd, werkt volledig computergestuurd, wat een online-evaluatie van de testen mogelijk maakt. Testen met deze proefmachine maakten al snel duidelijk dat de tot vandaag gebruikte implementatie- en kalibratietechnieken van de Tekscandruksensoren verre van optimaal zijn. Dat resulteert uiteraard in een slechte nauwkeurigheid; meetfouten van meer dan 50% zijn geen uitzondering.

2.2. Ontwikkeling methode voor kalibratie en dataverwerking

Door alle relevante Tekscansensoreigenschappen te analyseren en te testen, kon een innovatieve methode ontwikkeld worden voor de sensorkalibratie en voor de  post-processing van de meetdata. De methode behelst speciaal ontwikkelde kalibratieproeven (uitgevoerd in de eerder vermeldde proefmachine) in combinatie met een doorgedreven meetdataverwerkingsalgoritme (geprogrammeerd in Matlab). De nieuwe methode verhoogt de nauwkeurigheid en betrouwbaarheid van de contactdrukmetingen aanzienlijk. Testen in realistische testomstandigheden tonen aan dat de nauwkeurigheidsgraad stijgt met een factor 5 door het gebruik van deze techniek. De voordelen zijn aanzienlijk. Een concreet – enkel in technische termen te verwoorden – voorbeeld kan dit illustreren: de voor de nauwkeurigheid erg nadelige ‘tijdsafhankelijke sensordrift’ is tot op heden het grootste struikelblok bij het gebruik van de Tekscansensor. Bovenvermelde methode maakt het nu mogelijk om die ‘sensordrift’ te ‘compenseren’ (te filteren uit de resultaten). Naast het verhogen van de nauwkeurigheid van de sensor zorgt de nieuwe methode ook voor een volledige automatisatie van de kalibratiecyclus die de tijdrovende traditionele kalibratieprocedure vervangt. Dit vereenvoudigt het gebruik van de sensoren en verhoogt de efficiëntie van de hele procedure aanzienlijk. Er werd ook in de reële laboratoriumpraktijk onderzocht hoe de mogelijkheden van de Tekscansensor het best kunnen worden ingezet. Het resultaat van die studie is een reeks richtlijnen die orthopedische onderzoekers moet helpen om de intra-articulaire drukmetingen met de hoogst mogelijke nauwkeurigheid uit te voeren.

2.3. Visualisatiemethode van de drukmeting

Om de nauwkeurigere en betrouwbare meetresultaten correct te kunnen interpreteren, is een accurate voorstelling ervan uiteraard van cruciaal belang. Tot op heden werden observaties van drukverdelingen niet gelinkt aan hun corresponderende geometrische locatie op de prothese in kwestie. Hierdoor wordt het potentieel van deze drukmetingen slechts deels benut. Dit project komt tegemoet aan deze lacune door ook een meettechniek te ontwikkelen om de geometrische positie van de sensor op de prothese precies te kunnen definiëren. Door speciaal voor dit doel ontworpen 3D-geprinte kalibratieblokken te gebruiken in combinatie met een volautomatisch verwerkingsalgoritme, gebeurt de positiebepaling op een eenvoudige en snelle manier. Om een efficiënte en correcte interpretatie van de meetresultaten mogelijk te maken, werd samen met de techniek voor de sensorpositiebepaling ook een nieuwe methode ontwikkeld om de metingen te visualiseren. Die methode bestaat erin dat geobserveerde drukverdelingen synchroon worden gevisualiseerd op een waarheidsgetrouwe representatie van het contactoppervlak van de prothese.

3. Slot

Dit project biedt een totaaloplossing voor het verbeteren van intra-articulaire drukmetingen in het kniegewricht. Enerzijds verhogen de ontwikkelde technologische innovaties de nauwkeurigheid en het gebruiksgemak van het Tekscan-contactdrukmeetsysteem aanzienlijk. Anderzijds zijn deze technieken in een gebruiksvriendelijk product gegoten zodat de praktische toepassing ervan door orthopedische onderzoekers is gegarandeerd. Door op die manier bij te dragen aan een beter begrip van het kniegewricht, belooft het project onrechtstreeks ook te leiden tot een hogere tevredenheidsgraad bij toekomstige patiënten.

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Universiteit of Hogeschool
Master of Science in Electromechanical Engineering
Publicatiejaar
2015
Kernwoorden