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A New Metacarpophalangeal Joint Replacement Prosthesis

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A New Metacarpophalangeal Joint Replacement Prosthesis A New Metacarpophalangeal Joint Replacement Prosthesis BY THEODOROS PYLIOS A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY Biomedical Engineering Research Group School of Mechanical Engineering January 2010 I University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. Abstract Abstract The metacarpophalangeal joint is vital for hand function. It is frequently affected by rheumatoid arthritis or osteoarthritis and in some cases the diseased joint is replaced with an implant. The past and current metacarpophalangeal joint replacements can be divided into three main categories: hinge implants, flexible implants and surface replacement implants. There is some frustration among hand surgeons as these implants fail in vivo in comparison with the replacement of larger joints such as the hip or knee. The aim of this study was a new design concept for the replacement of the diseased metacarpophalangeal joint. The biomechanics of the diseased rather than the normal metacarpophalangeal joint have been considered during the design requirements procedure. Retrospective analysis of the past and present designs has been considered. Following selection of the concept of the new metacarpophalangeal joint replacement design well established methods like lubrication analysis and contact stress analysis studies, laboratory wear tests and finite element analysis studies have been used for the evaluation of the final design. In this study a new metacarpophalangeal joint replacement has been proposed. The new implant is intended to provide a functional range of motion, sustain the forces that a diseased joint experiences and provide pain relief for the patient. The new proposed metacarpophalangeal joint replacement design tries to combine the benefits of a one piece flexible implant with those of a surface replacement implant design that utilises the soft layered concept which has been proposed for larger synovial joints. I Acknowledgments Acknowledgments I would like to thank my supervisor Dr Duncan E.T Shepherd for his valuable guidance, understanding, patience and support throughout this research project. I would also like to thank Professor David W.L. Hukins for his encouragement and support all these years. I would also like to thank the School of Mechanical Engineering of the University of Birmingham for the provision of the departmental scholarship that made this research work possible. I would also like to thank Dr. Stergio Lolas, Dr Aziza Mahomed, Miss Purvi Patel, Miss Farnaz Jabbary Aslani, Dr Daniel Espino, Mr Jugal Parekh, Dr Lei Dang, Dr Laura Leslie and all the other colleagues in the School of Mechanical Engineering of the University of Birmingham for providing a friendly and comfortable academic environment. I would also like to thank my parents Georgios and Maria and my brother Vasilis for their support and encouragement all these years. Finally, I would like to thank and dedicate this thesis to my wife Nadia for her continuous encouragement, support and understanding during the last few years and to my new born lovely daughter that comes to my life just before this final draft was submitted. II Table of contents Table of Contents Abstract .................................................................................................................................. I Acknowledgments ................................................................................................................ II Table of Contents ................................................................................................................ III List of Figures .................................................................................................................. VIII List of Tables ..................................................................................................................... XII Chapter 1 ............................................................................................................................... 1 Introduction .......................................................................................................................... 1 Chapter 2 ............................................................................................................................... 3 Biomechanics of the normal and diseased metacarpo-phalangeal joint ......................... 3 2.1 Introduction ...................................................................................................................... 3 2.2 Normal MCP joint biomechanics ..................................................................................... 4 2.2.1 Range of motion ........................................................................................................ 4 2.2.2 Centre of rotation ....................................................................................................... 6 2.2.3 Forces ........................................................................................................................ 6 2.2.4 Tendons, muscles and ligaments ............................................................................... 9 2.3. Diseased MCP joint biomechanics ................................................................................ 10 2.3.1 Diseases ................................................................................................................... 10 2.3.2 Range of motion ...................................................................................................... 12 2.3.3 Forces ...................................................................................................................... 12 2.4 Summary ........................................................................................................................ 13 Chapter 3 ............................................................................................................................. 14 Metacarpophalangeal Joint Prostheses ............................................................................ 14 3.1 Introduction .................................................................................................................... 14 3.2 Hinge prostheses ............................................................................................................. 14 3.2.1 Brannon and Klein prosthesis .................................................................................. 14 3.2.2 Flatt Prosthesis ........................................................................................................ 15 3.2.3 Griffith- Nicolle prosthesis ...................................................................................... 15 3.2.4 Schetrumpf prosthesis ............................................................................................. 16 3.2.5 Schultz prosthesis .................................................................................................... 17 3.2.6 Steffe prosthesis ...................................................................................................... 18 3.2.7 St George – Buchholtz prosthesis ........................................................................... 19 3.2.8 KY Alumina ceramic prosthesis .............................................................................. 19 3.2.9 Minami Alumina prosthesis .................................................................................... 20 3.2.10 Strickland Prosthesis ............................................................................................. 21 3.2.11 Walker Prosthesis .................................................................................................. 21 3.2.12. Weightman Prosthesis .......................................................................................... 22 3.2.13 Mathys prosthesis .................................................................................................. 23 3.2.14 Link arthroplasty prosthesis .................................................................................. 24 3.2.15 WEKO Prosthesis .................................................................................................. 25 3.2.16 Digital Operative Arthroplasty DJOA prosthesis .................................................. 25 3.2.17 Daphne Prosthesis ................................................................................................. 26 3.3 Flexible one-piece prostheses ......................................................................................... 27 3.3.1 Swanson prosthesis .................................................................................................. 27 III Table of contents 3.3.2 Niebauer prosthesis (Cutter) .................................................................................... 31 3.3.3 Soft Skeletal Implant Avanta (previously known as the Sutter) ............................. 32 3.3.4 Neuflex prosthesis ..................................................................................................
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