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1 立論 Effects of Attachment of Patella-Tendon to Modular Oncology Prosthesis 逸年六

4 不力了 50 了度度力猪論力力論異利狀了泥立 500N 力了度力 15 力論降 10.8% MVMS 力 20.8% MVMS 力泥若力 300N 450N 11.2% 泥 4.2% 7.1% MVMS 力力力力力臨療參 CCIS 泥 I

5 Abstract Attachment of patella-tendon to the modular knee joint prosthesis is usually fixed to the middle position, but it is different from original attachment location for left and right knee in human body. This research is to investigate the attachment effects of patella-tendon ( PT ) in modular oncology prosthesis. Total 50 subjects were collected in this research and CT images of human knee joint in sagittal plane were used to generate a three-dimensional model for defining PT length and rotation angle of tibiofemoral. An in-vitro experiment of pig PT were performed to obtain the strength of PT and to test three design of locking devices of PT of modular knee prosthesis. A finite-element model of human tibial joint consisting of cortical bone, cancellous bone, and bone cement was used to simulate the loading condition of standing by one leg with 500N loading. The model of prosthetical tibial stem inserted with various interface geometry of collar angle (0, 15, 30, and 45 ) are used to investigate the effect of loading transmission. Results show that the collar angle design of 15 indicates the smaller maximum von Mises stress ( MVMS ). Moreover, rotation angle of tibiofemoral is divided into three groups to discuss the influence of original and artificial PT position. Results show that different artificial PT position decreases 10.8% MVMS on implant and 20.8% MVMS on cortical bone only as compared with the original one. With attachment force as 300N and 450N to implant by the soft tissue of PT, MVMS on implant increased as 11.2%, MVMS on bone cement as 4.2%, and MVMS on cortical bone as 7.1%. Result of this research reveals the significance of attachment of PT in prosthesis and can be referred in oncology surgery. Keywords Patella-tendon, Modular joint prosthesis, CAE, Conical-collared intramedullary stem CCIS, Bone cement. II

6 逸老老論老識識論利聯龍臨識瑩老識諸論不吝見更力識了龍精神勵旅 III

7 錄..... Abstract 錄.. 錄.. 錄... 論 CAD 立量流立 CAD 立 CAD Implant 量.. 28 IV

8 料例料度度度論猪力料論立立力例例不度不度論 V

9 六論度度拉度論論參 VI

10 錄 UOC 例料 UOC UOC UOC 流流狀切 Amira CT import 輪廓 Implant SolidWorks 讀 *.dxf *.dxf 輪廓 CAD Implant 兩行離離 Implant 度 Implant Implant 立流切立零立 Implant 度量 SolidWorks 量度度狀立度流...42 VII

11 A 度度流落落兩兩量度 M72L01 F42L 兩隆 A 立量 B A 聯 MV-3A 立切念猪 MTS 料 MTS BIONIX A C 拉裂 Amira 讀 UOC 立 Coordinate Ansys 力 Conical-collared intramedullary stem 度 Max. von Mises stress Conical-collared intramedullary stem 度 Max. von Mises stress 83 VIII

12 5.17 Max. von Mises stress 泥 Max. von Mises stress Max. von Mises stress Max. von Mises stress 力量 Max. von Mises stress 力 300N 泥 Max. von Mises stress 力 300N Max. von Mises stress 力 300N Max. von Mises stress 力 300N 力 MVMS 力 300N 力泥 MVMS 力 300N 力 MVMS 力 300N 力 MVMS 力 300N.97 IX

13 錄例料兩兩量度拉力 Device A 數力 Patella-Tendon-Tibia 數力力理料數料料力數 ASTM 泥料不度料 Max. von Mises stress MVMS 50N~250N MVMS 300N 450N 力 MVMS 300N 450N MVMS MVMS MVMS 不力 300N 不度料 MVMS.103 X

14 論 1-1 年來年年臨了力不力 [1-3] 臨罹臨易切臨療 Limb salvage surgery [4] 切留切行良了 Intramedullary Stem 狀 CAD 行 Computer-Aided Engineering, CAE 猪力拉數度度了度了度度論 1

15 力 1-2 聯 United Orthopedic Corporation, Hsinchu, Taiwan 列 [5] 1.1 不切切度不不若力立 CAD 裡行力異度不數 2

16 1.1 - UOC Custom-made Knee joint system Proximal Tibial 1-3 離易 Tibiofemoral joint Patellofemoral joint 不力量 Mobility 度 Stability 3

17 1-3-1 Distal femur Lateral femoral condyle Medial femoral condyle Proximal tibia 了 1.2(a)(b) Femoral condyle 不狀 Sagittal plane 率 Plateau Lateral tibia condyle Medial tibia condyle 隆 Intercondylar eminence 隆 Intercondylar fossa 狀不兩不度 Full extension 兩兩 Patellar surface 1.2(c)(d)(e) 滑數 Extensor 力力益 Quadriceps 力兩參 1.2 (8) 隆 Tuberosity of tibia (17) Apex of patella 3-3 度參 1.2 (13) Lateral condyle of femur 1.3 4

18 (a) ( ) (b) (c) (d) ( ) (e) 1.2 [6] Bones of right knee joint and patella 1 Femur 2 Patellar surface of femur 3 Lateral epicondyle of femur 4 Intercondylar eminence of tibia 隆 5

19 5 Lateral condyle of tibia 6 Position of tibiofibular joint 7 Head of fibula 8 Tuberosity of tibia 隆 9 Fibula 10 Shaft of tibia 11 Popliteal surface of femur 12 Intercondylar fossa of femur 13 Lateral condyle of femur 14 Patella 15 Base of patella 16 Anterior surface of patella 17 Apex of patella 18 Articular surface of patella 6

20 (a) (b) 1.3 [6] Bones of leg, right tibia and fibula 1 Lateral condyle of tibia 2 Position of tibiofibular joint 3 Head of fibula 4 Interosseous border of tibia 5 Shaft of fibula 7

21 6 Interosseous border of fibula 7 Lateral surface of fibula 8 Position of tibiofibular joint 9 Lateral malleolus 10 Medial condyle of tibia 11 Tuberosity of tibia 隆 12 Shaft of tibia (diaphysis) 13 Anterior margin of tibia 14 Medial malleolus 15 Inferior articular surface of tibia 16 Intercondylar eminence 隆 17 Soleal line 18 Medial border of tibia 19 Posterior surface of tibia 20 Malleolar sulcus of tibia 21 Malleolar articular surface of fibula 22 Apex of head of fibula 23 Posterior surface of fibula 24 Posterior border of fibula 25 Medial intercondylar tubercle 26 Posterior intercondylar area 27 Anterior intercondylar area 28 Lateral intercondylar tudercle 8

22 , 罹切六年更了復類不都不復療療不復力了切不不不度不歷 X 量切聯 United Orthopedic Corporation, Hsinchu, Taiwan 不臨不 [5] 9

23 1.4 - UOC Custom-made Knee joint system Distal Femur 1.5 UOC Custom-made Hip joint system 10

24 1.6 UOC Custom-made Shoulder joint system 1-5 見臨療量良行 [7-9] 臨罹都來行 [10-12] 1961 年 Barr 行 [13] [14-15] 不 11

25 臨狀狀率 [16] 流利 X 留行 [17-19] 力行料力度力量力力力度來論力不力力 Mandell 2004[27] 年利了狀泥度來論若利不力 ( Stress ) ( Strain ) 數利立行諸不狀不不狀省料 [20-23] 力 1992 年 Zavatsky 1997 年 Toutoungi et al. [35-36] 立立 12

26 狀數來來力 Wismans 1980[37] 年料利力力立理論度利來類力利來立列 Main list of references Author 年 Year Content Barr 1961 切 [13] 六車 Ericson 1987 力力 [31] Yang 1998 [14] 1999 立 [24] Yang

27 [15] Minns 2003 CT RP [18] 立利 2003 Adams [25] 2003 林 2004 利 DDH 行力 [23] 力 [26] 利理泥 Mandell 2004 度力 2000N N 論力 [27] 14

28 1-6 猪力論度力量立輪廓輪廓 Amira TGS Inc., San Diego, CA, U.S.A. 讀 Computer tomography, CT CT 輪廓輪廓輪廓料 *.dxf SolidWorks SolidWorks Corp., Boston, U.S.A. 輪廓料利 SolidWorks 行拉兩量度度 ANSYS Swanson Analysis Inc., Huston, PA, U.S.A. 讀 SolidWorks *.sat 了猪拉數行流

29 A (Computter tomography) B 理 Amira Medical image Adjust value of the image 輪廓 Select the outline 3-D vision model 量度度 Measurement C 輪廓 (*.dxf) 行 3-D contours model 1. DXF 2. 利不 (Spline) 輪廓 3. 拉 3-D Solid Model D 量 1. 隆量度 2. 量度 3. 量 a 量 Procedure A Building 3-D geometry model and measuring tendon data 16

30 E 金立 (3-D Solid Model) F 金立 (3D Mesh Model) G (Boundary condition ) 1. 料 2. 力量 (Couple Force) 3. (Constrained) H 猪拉數 (Tension experimentation) I 力 Finite element analysis of biomethanics 1. 度 2. 力量 3. 力量 b 猪拉 Procedure B Building finite element analysis model and tension experimentation 1.7 流 17

31 1-7 論六論論論 CAD 立 CAD Implant Bone 利料度度猪力易料行拉 20 行拉行 - 流立流料六論量拉度論 18

32 CAD 立 2-1 量流立輪廓輪廓 Amira TGS Inc., San Diego, CA, U.S.A. 讀 Computer tomography, CT CT 輪廓聯 Implant IGES 理輪廓輪廓料 *.DXF SolidWorks SolidWorks Corp., Boston, U.S.A. 輪廓料利 SolidWorks 行拉 2.1 流 CT or MRI 理 (Amira 輪廓 ) Amira SolidWorks 讀 *.DXF (Implant) IGES 2.1 流 Procedure of building deficient knee joint 3-D solid model 18

33 2-1-2 立 CT Transverse plane DICOM 輪廓 Amira 讀 CT 2.3 CT 輪廓 CT DICOM 讀 Amira 裡 Data Window 來參 2.2 Grey value 參 2.4 輪廓 Quadriceps femoris muscle 輪廓 Patellar ligament 綠輪廓 Gastrocnemius muscle 輪廓 Cortical bone 398 輪廓

34 2.2 狀切 [6] Sagittal section through the knee joint 1 Femur 2 Quadriceps femoris muscle 3 Suprapatellar bursa and articular cavity 滑 4 Patella 5 Patellar surface articular cartilage 6 Intrapatellar fat pad 7 Patellar ligament 8 Tibia 9 Tibial nerve 神 10 Addu ctor magnus muscle 20

35 11 Popliteal vein 12 Semitendinosus muscle 13 Semimembranosus muscle 14 Popliteal artery 15 Gastrocnemius muscle 16 Anterior cruciate ligament 17 Posterior cruciate ligament 18 Popliteus muscle 19 Soleus muscle 2.3 Amira CT import 2.4 Selected soft tissue, patella and tibiofemoral joint 21

36 2.5 輪廓 Visual and contour model of 3-D left knee joint CAD 立 398 輪廓聯 (Implant) IGES 2.6 Implant 了 Implant mm 398 Contour 不度度 148mm 2.8 Amira Contour *.dxf SolidWorks 2.9 參輪廓 mm 輪廓留輪廓參不輪廓利 SolidWorks 拉輪廓行拉 22

37 Implant Relation between implant and dimensions 2.7 Deficient knee joint model 2.8 Simplified deficient knee joint model 23

38 2.9 SolidWorks 讀 *.dxf Imported dxf format to SolidWorks 2.10 *.dxf 輪廓 Simplified contour of dxf format 2.11 CAD CAD model of deficient tibiofemoral joint 24

39 2-2 CAD Implant 聯 Implant Implant 行 Implant Deficient point of tibia and axis of implant 2.13 Limitation of the coincident concurrent 25

40 Select this plane Select Top Plane 2.14 兩行 Constraint of parallel planes 2.15 Anterior view of assembly 26

41 (a)lateral view (b) 輪廓 Contour of implant and femur 2.16 Lateral view and top view of assembly 2-3 量 Amira 讀 MRI CT 料來輪廓度來 CAD model 來切 Tibia Implant 離 CAD model 立理切來臨 27

42 理量來 Femur 度更 2.17 離離 Implant 度切 Tibia Implant Implant 2.18 Implant 立流了切 2.21 零 2.22 零 2.23 利 2.17 離離 Implant 度 Height of soft tissue distance femur bottom distance and Implant 28

43 2.18 Implant Relationship between model and Implant 2.19 Implant Constraints of Implant and Tibia are coaxial 29

44 立 2.20 立流 Flow chart of assembly 2.21 切 30

45 2.22 立零 Assembly divides into three components 2.23 立 Finish situation of after assembly 31

46 料 3.1 聯 United Orthopedic Corporation Implant 利利 SolidWorks 立 CAD 量料量數列 3.1 立立 ID N 3.1 Implant 32

47 例料例料 NO M72 LN01 F57 LR02 F42 LR03 FN LR04 FN LR05 MN NR06 FN LR07 F35 LR08 M29 LR09 M66 LR10 Visual Model Sex M F F F F M F F M M Age N N N N Left knee Right knee LCS X Y Z Left Knee Tendon Length (mm) RCS X Y Z Right Knee Tendon Length (mm) Bad Bad Bad Bad Bad Bad

48 例料 NO M52 LR11 F63 LR12 F64 LR13 M29 LR14 M19 LR15 M10 LR16 M56 LR17 F62 LR18 F68 LR19 M73 LR20 Visual Model Sex M F F M M M M F F M Age Left knee Right knee LCS X Y Z Left Knee Tendon Length (mm) RCS X Y Z Right Knee Tendon Length (mm)

49 例料 NO F50 LR21 M65 LR22 M55 LR23 M39 LR24 F66 LR25 M65 LR26 Visual Model Sex F M M M F M Age Left knee Right knee LCS X Y Z Left Knee Tendon Length (mm) RCS X Y Z Right Knee Tendon Length (mm)

50 力念利 CT 不度切臨參 Amira SolidWorks 來論度度 3-2 度切切切度度不隆量度連隆離 3.1 度 (L) 連 P p 隆 P t 離 L PP...(3.1) p t 度量利 Amira 裡量離量 CT 量不裡不 36

51 留拉隆離 3.2 量量不 2~3mm 來立度料參 P p P t (a)anterior view (b)lateral view 3.2 度量利 Amira *.DXF SolidWorks 輪廓不輪廓拉行拉 CAD 3.3 便切不切量量量數異度 Amira 量不 CAD 量 37

52 3.3 SolidWorks 量度 3-3 度度 3.4 來 B A 度裡立 Z 來度 3.2 利來參不 Z 度 (θ) D t ± D l ± + ( ) - ( ) θ DD t l (3.2) 38

53 來 Amira 利 Image Segmentation Editor 狀利 ObliqueSlice 3.5 D t D l θ 3.4 度 3.5 狀立 39

54 狀不易料量異力來度度來量度 Rotation of patella-tendon, RPT 3.6 Φ 3.6 Amira 裡 3.6 兩兩量度異來量度 Φ 裡量立離裡量兩利 CAD 來度兩利隆兩論 40

55 3-3-1 度 3.7 流利 Amira 輪廓 *.DXF SolidWorks 輪廓利 3.8 Posterior condyle line Intercondylar fossa of femur A A 連 3.9 度 3.10 Amira *.dxf SolidWorks 輪廓連 A A 隆隆連 3.7 度流 41

56 3.8 A A 3.9 A 42

57 3.10 度流利 Amira 輪廓 *.DXF SolidWorks 輪廓利輪廓輪廓兩兩輪廓落輪廓裡 PCL offset 來度利立 3.8 隆兩兩度量 43

58 3.16 Amira *.dxf SolidWorks 輪廓兩兩 (P) (P) 3.11 度流 44

59 3.12 落 3.13 落 45

60 3.14 兩

61 3.16 兩量度論兩 Model 兩論列 M72L01 F42L03 兩 M72L01 F42L03 47

62 M72L01 量度 4.3 量 6.6 量不兩不劣 F42L03 量 14.1 利量度量 F42L03 利兩度異 3.18 兩度不 M72L01 裡兩度不 M72L01 立兩量來利來量度量 3.2 兩兩量度 Method 1 Angle of measurement Method 2 Angle of measurement M72L F42L

63 3.18 兩 3-4 利 3-3 立立 6 隆 A A 立 1 X 6 Y Z 行輪廓 B 利量 A X0, Y0, Z0 B ( X1.3, Y-1.63, Z3.58 ) cm 裡了度度了 50 例料利不 49

64 猪力論不異數 A 3.19 隆 A 立 B A 3.20 量 50

65 B A 3.21 B A 51

66 猪力利 MasterCam CNC software, inc., Tolland, USA CAM 輪廓路 NC 切 MV-3A 立切 4.2 Fanuc Series 0-M 數行 NC 路來 4.3(a) 4.1 聯 52

67 4.2 MV-3A 立切 4-2 料猪來裡不聯行利 Kessler suture method, 4.3 來行拉 4.4 念了不螺 53

68 4.3 Clip device (moved end) Fastener Patella Patella-tendon Anchorage device of prosthesis Clip device (fixture) 4.4 念理 20 年猪切留 54

69 了切 18 隆 Tibial tuberosity 兩狀利螺螺易理理冷行拉來 No.5, Polyester suture, J&J 來行猪連利行 18 - 六不 A 4.5(a) B C 4.5(b)(c) 行 UOC Howmedica 兩猪行 D 4.6(d) (a)new UOC Product (b) UOC Product (c) Howmedica Product

70 (a)device A (b)device B (c)device C (d)patella-tendon-tibia 4.6 猪 MTS 年猪 2 理 - - 行度拉 18 - 不 18 - 易料行拉利料 (MTS BIONIX 858, MTS Inc., U.S.A.) 4.7 行拉拉力狀行拉拉 n=2 利不拉 Device A n=6 Device B n=6 Device n=6 20 行拉 20-30N 力 56

71 1mm/sec 拉力行 4.8 A C 拉裂 4.1 力力 300N~400N 列 Device A 數力 4.2 拉離 31mm 65mm 力 354N 力 190N 4.3 Patella-Tendon-Tibia 力利利拉異力 1100N 裂狀數 4.4 拉 No.5, polyester suture, J&J 拉數 MTS Adjustable upper plate Cylindrical column Control panel 4.7 料 MTS BIONIX

72 4.8 A C 拉裂 4.1 拉力 Device A Device B Device C Patella-Tendon-Tibia No.5 polyester suture (1.43) 262 (1.4) 438 (1.65) 1177 (1.32) (1.63) 361 (1.13) 381 (1.22) 1096 (1.28) (1.21) 344 (1.44) 376 (1.57) (1.35) 328 (1.63) 350 (1.29) (1.23) 330 (1.18) 379 (1.31) (1.53) 341 (1.39) 393 (1.17) Average Standard err Unit N (cm), ( ) is tendon width. 58

73 4.2 Device A 數力 4.3 Patella-Tendon-Tibia 數力 59

74 4.4 力 4-4 論 A B C 力拉數兩兩數 C 拉力 4.5 理 B 易力離不易 A 不力量 A B 拉力離數 C 拉兩力力力便離 A C 度便 A B C 60

75 C A 力 A 4.5 理 Device A Device B Device C 力易力離易 X The best, Good, General X No 61

76 5-1 兩參 Minns 2003[18] 年立輪廓輪廓 Amira TGS Inc., San Diego, CA, U.S.A. 讀 Computer tomography, CT CT 輪廓輪廓輪廓料 *.dxf SolidWorks SolidWorks Corp., Boston, U.S.A. 輪廓料利 SolidWorks 行拉 ANSYS Swanson Analysis Inc., Huston, PA, U.S.A. 讀 SolidWorks *.sat 行力力參 [21] 論泥力立 F42R03 CT 料年 42 女 50kg 62

77 CT Transverse plane 3mm DICOM 輪廓 Amira 讀 CT 5.1(a) CT 輪廓 CT DICOM 讀 Amira 裡 Data Window 來輪廓輪廓 5.1(b) Grey value 參 5.1(b) 輪廓 Cortical bone 藍輪廓 Cancellous bone 150 輪廓 5.2(a) 5.2(b) 63

78 (a)amira CT import (b) 輪廓 ( ) Contour of tibia 5.1 Amira 讀 64

79 (a) 輪廓 3-D visual knee joint contour model (b) 3-D visual knee joint model

80 5-1-2 立聯聯 CAD 5.3(a) CAD UniGraphics 16.0 IGES IGES 料行行參數更行聯 SolidWorks 量利來 5.3(b) 9mm 度 100mm (a) UOC Implant 66

81 (b)simplified Implant 5.3 UOC 立 Amira *.dxf SolidWorks 輪廓參不輪廓度 mm 切 mm 利 SolidWorks 拉輪廓行拉 5.4 CAD X f 行 Z 行 X t Y Z 泥力立泥 67

82 5.4 連兩路 (a) (b) 連行

83 Z Y X f Z Y 5.6 X t 5.7(a)(b) CAD 裡輪廓 CT 5.8 CAD 5.6 X t Y Z

84 Z Y X t (a) (b)

85 (a)amira 裡 X Y Z (b)amira SolidWorks

86 5.9 Coordinate SolidWorks 了力利 ANSYS 行力力

87 A. Simplicity Finite Element Analysis Model (Import Solidworks File *.sat) B. 料 1. (Element Type) 2. 料 (Material Proprties) 數 (Young s Modulus, E) (Poisson s Ratio, υ) 理 (Pre-Processing) C. 林 (Booleans -Glue) D. (Volume Meshing) 1.Mapped Meshing 2.Free Meshing E. (Loads and Constrains) 1. (BC) => 2. => 力力理 (Post-Processing) F. (Analysis) G. (Results) => 列 (List) (Plot) H. (check result) => 理 5.10 Steps of finite element analysis 73

88 5-2 力 SolidWorks *.sat ANSYS 行理泥 ANSYS 林 Booleans operation Glue 5.11(b) 不行 Map mesh 5.11(a) 不 Solid95 3-D 20-node structural solid Solid95 20 Tetrahedral Pyramid Prism 立不 3-D Meshing Smart Mesh 5.11(a) 料 5.1 Cortical bone Cancellous bone 塞了 Bone marrow 狀力度不 Cortical bone 連度 Isotropic 料數 Young s modulus, E 17000MPa Poisson s ratio, υ 0.3 Cancellous bone 狀 Trabeculae 連狀沈都 74

89 不不不列列力量數 70MPa 0.2 泥 Bone cement 數 2200MPa 0.3 Implant 金 (Co-Cr-Mo) 數 MPa 0.3 Ultra-High Molecular Weight Polyethylene UHMWPE 數 1016MPa 0.46 力 5.11(c) (1) 力 Loading condition 力立力狀力參 [21] 力力 Couple force 5.12 量 F = 214.9i j k F = 214.9N, F = 232.3N, F = N x y (2) Boundary condition Constrained z 75

90 (a) Use Map mesh in the regular place use Smart mesh in the irregular place (b) Cross section of total glue model (c) Boundary condition of the finite element model 5.11 Ansys - 76

91 5.12 力 5.1 料數料 [21,28] Material coefficient of the finite element model and material property Material (UHMWPE) (Implant) 泥 (Bone cement) (Cancellous bone) (Cortical bone) Young's Poisson's Element Modulus Ratio Type E (MPa) Solid Solid Solid Solid Solid 95 Material Property (isotropic) (isotropic) (isotropic) (isotropic) (isotropic) 77

92 5-3 0, 15, 30, 例 mm round, 15, 30 +1mm round 異度異數兩行數 15 + 力 UHMWPE 泥力降說力不力力不易 UHMWPE 力 30 + 切 YZ 15 數異利切力切若力切力數異力參說例力 78

93 (a) Collar angle 15 +R. (b) Collar angle Conical-collared intramedullary stem (c) Collar angle 30 +R. 79

94 Angle Analysis-Bone cement Angle Analysis-Cancellous bone Max.von Mises stress(mpa) Angle( ) Max.von Mises stress(mpa) Angle( ) (a) Max. von Mises stress of Bone cement with various conical-collar angle(cca) (b) Max. von Mises stress of Cancellous -bone with various CCA Angle Analysis-Cortical bone Max.von Mises stress(mpa) Angle( ) Max.von Mises stress(mpa) (c) Max. von Mises stress of Cortical bone with (d) Max. von Mises stress of Implant various CCA with various CCA 5.14 度 Max. von Mises stress Max. von Mises stress of components with various conical-collar angle (The starting point is 15 +Round) 80

95 5-3-2 例度 0,15,30,45 +1mm 5.15( 0 ~45 ) 度 5.4 度力泥兩度力 15 度力來度力 UHMWPE 力力 (a) Collar angle 0 +R.(b) Collar angle 15 +R.(c) Collar angle 30 +R.(d) Collar angle 45 +R Conical-collared intramedullary stem 81

96 Angle Analysis-Bone cement Angle Analysis-Cancellous bone Max. von Mises stress(mpa) Max. von Mises stress(mpa) Angle( ) Angle( ) (a) Max. von Mises stress of Bone cement with various CCA (b) Max. von Mises stress of Cancellous -bone with various CCA Angle Analysis-Cortical bone Max. von Mises stress(mpa) Angle( ) Max. von Mises stress(mpa) (c) Max. von Mises stress of Cortical bone with (d) Max. von Mises stress of Implant various CCA with various CCA 5.16 度 Max. von Mises stress Max. von Mises stress of components with various conical-collar angle 82

97 5.2 料力數 [29] Dept. of orthopedics corrects the stress and modulus of the material Materials σ yield (MPa) σ ultimate (MPa) E (GPa) Stainless-steel Co-alloy Ti-alloy Bone PMMA UHMWPE Patella-tendon ASTM 泥料 No.F451-99ae1 [30] ASTM material property standard of bone cement ASTM 泥泥 Property Testing value of bone cement Max. doughing time, min 5.0 Settting time, min 5~15.0 度 Max. temperature, 90 度 Min compression strength, MPa 60 量 Max. deformation amount, mm

98 5.4 不度料 Max. von Mises 力 Max. von Mises stress of components with various conical-collar angle Characteristics Round Round Round Round UHMWPE (22.176) (22.219) (22.153) (22.195) (22.101) Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Full Part cross-section Implant (snap-section) Unit MPa 不度例例力力 1mm 若更滑度不度兩力 Mandell [27] Proximal ingrowth 度 0 ~60 力量量力來 5.17~ Max. von Mises stress MVMS 力 84

99 (a) Anterior view (b) Posterior view 5.17 Max. von Mises stress Max. von Mises stress of Implant (a) Anterior view (b) Posterior view 5.18 泥 Max. von Mises stress Max. von Mises stress of Bone cement 85

100 (a) Anterior view (b) Posterior view 5.19 Max. von Mises stress Max. von Mises stress of Cancellous bone (a) Anterior view (b) Posterior view 5.20 Max. von Mises stress Max. von Mises stress of Cortical bone 86

101 5-3-4 不度論力度 0 45 力泥度力力 Mandell [27] 立理量力 micromotion 刺 stimulation 度更 Mandell 理泥力離 No ingrowth N 力量 25MPa 力裡力了 2 林 [26] 100mm 離力量力力了立論力理 5.4 泥降力良降力更度 87

102 利度 15 猪拉數來論利 SolidWorks 3-4 洞立輪廓利量 (X2.54, Y-22.77, Z47.05) mm 裡行 Map mesh 不 Solid95 Free mesh 5.22 力 Ericson [31] 六車力力 BW, Body weight 若 50kg 女力 450N 力量拉數利力量不更力量力量 300N 4.1 立 300N 450N 力 50N 100N 150N 200N 250N 力力量力量 5.23 行力 ANSYS Max. von Mises stress

103 5.5 六數數 50N 100N 150N 200N 250N 力 MVMS 力力量力力例 5.6 了 300N 450N 力 MVMS 數 5.6 力量 300N 450N 力 263.2MPa 292.6MPa 了 11.2% 力泥力 16.8MPa 17.5MPa 了 4.2% 力力 59.2MPa 63.4MPa 了 7.1% 力路樓力力 F = 214.9N, F = 232.3N, x y Fz = N 力力 5.24~27 量力 300N MVMS 力更不力參 [38] 力 F = N F = N F = N 5.7 x y 量力力力若力 300N 450N 力降 5.8% 泥 8% 8.5% 力 5.28~31 力 300N 力 MVMS z 89

104

105 (a) Input the coordinate value (b) Position of application of force in the space 5.23 力量 5.5 Max. von Mises stress ( 50N~250N ) Mesh size smrt size 4 Load 50kg Couple Force 50kg Couple Force 50kg Couple Force 50kg Couple Force 50kg Couple Force 50kg Couple Force Tendon Force 50N Tendon Force 100N Tendon Force 150N Tendon Force 200N Tendon Force 250N Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa 91

106 5.6 Max. von Mises stress 300N 450N Mesh size smrt size 4 Load ultimate 50kg Couple Force Tendon Force 300N 50kg Couple Force Tendon Force 450N 50kg Couple Force Tendon Force 300N Tendon Force 450N Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa (a) Anterior view (b) Posterior view 5.24 Max. von Mises stress 力 300N 92

107 (a) Anterior view (b) Posterior view 5.25 泥 Max. von Mises stress 力 300N (a) Anterior view (b) Posterior view 5.26 Max. von Mises stress 力 300N 93

108 (a) Anterior view (b) Posterior view 5.27 Max. von Mises stress 力 300N 5.7 力 MVMS 300N 450N Mesh size smrt size 4 Load ultimate 50kg Couple Force Tendon Force 300N 50kg Couple Force Tendon Force 450N 50kg Couple Force Tendon Force 300N Tendon Force 450N Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa 94

109 (a) Anterior view (b) Posterior view 5.28 力 MVMS 力 300N (a) Anterior view (b) Posterior view 5.29 力泥 MVMS 力 300N 95

110 (a) Anterior view (b) Posterior view 5.30 力 MVMS 力 300N (a) Anterior view (b) Posterior view 5.31 力 MVMS 力 300N 96

111 量度 Φ ~10 n=25 11 ~20 n=15 21 n=10 裡行力 Max. von Mises 力數利力力數理來不降 10.8% 20.8% 力 97

112 5.8 Max. von Mises stress ( 15 +Round ) Load 50kg Couple Force Tendon Force 300N ultimate Right knee Left knee Coordinate System Value Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa 5.9 Max. von Mises stress ( 15 +Round ) Load 50kg Couple Force Tendon Force 300N ultimate Right knee Left knee Coordinate System Value Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa

113 5.10 Max. von Mises stress ( 15 +Round ) Load 50kg Couple Force Tendon Force 300N ultimate Right knee Left knee Coordinate System Value Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa 5.11 不力 300N Mesh size smrt size 4 Load ultimate 50kg Couple Force 50kg Couple Force Group 1 Group 2 Group 3 Tendon Force 300N Tendon Force 300N Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Unit MPa 99

114 六論 6-1 度度利 Amira CT 量量不 CAD 料量度來量度 Rotation of patella-tendon, RPT 利 CAD 數數了量度 Amira 量數度量利度數參 6-2 拉參 Ericson 1987[31] 料利車力力 BW, Body weight 70kg 車力 630N 50kg 女車力 450N A B C 數來 300N~400N 拉力不力若力量更益復 A C B A B 100

115 來來力離 A 若力來更 6-3 度度切 YZ 狀切力 MVMS 197MPa 199.3MPa 197.7MPa 195.6MPa Plot 力 MVMS 207.3MPa 213.3MPa 214MPa 209.8MPa PE 力 MVMS 力 22MPa 泥力 MVMS 15.4MPa 14.6MPa 17.2MPa 19.2MPa 力 MVMS 52.4MPa 50.9MPa 51.3MPa 51.2MPa 度 MVMS 0.3MPa MVMS 降力 6.1 泥度力度力泥度力 15 度力復力度來力度

116 度力來力度來度更 6.1 不度料 MVMS Characteristics ultimate Round Round Round Round UHMWPE Implant (Co-Cr-Mo) Bone cement Cancellous bone Cortical bone Full Part cross-section Implant (snap-section) Unit MPa 6-4 力力量力 300N 450N 拉力力例 11.2% 泥 4.2% 7.1% MVMS 力路樓量力 F = 214.9N, x Fy = 232.3N, F = N 力 z 力力力 102

117 力 450N 拉力力數 300N 拉力 300N 450N 降 5.8% 泥 8% 8.5% MVMS 力力量力力力力 263.2MPa 降 234.7MPa 力 59.2MPa 降 46.9MPa 降 10.8% MVMS 力 20.8% MVMS 力泥 103

118 論度度了度利狀了臨立 500N 力, 了度力猪論數來力力論異了 50 度度論 7-1 論論 (1) 了 50 理度度便行 (2) 力量力力力降 10.8% MVMS 力 20.8% MVMS 力 104

119 泥來說若裡隆不 (3) 了論度力聯 15 (4) 若力路樓力力 F = 214.9N, F = 232.3N, F = N x y 力力 300N 450N 11.2% 泥 4.2% 7.1% MVMS 力力力 z 7-2 不立立臨來 (1) 來力量更狀 (2) 來泥更狀 (3) 力力力 (4) υ 105

120 參 [1] Bartel, D.L., Rawlinson, J. J., Burstein, A. H., Ranawat, C. S., Flynn, W. F., Stresses in Polyethylene Components of Contemporary Total Knee Replacements, Clini. Orthop. Rela. Resea., pp [2] Godest, A.C., Beaugonin, M., Haug, E., Taylor, M., Gregson, P.J., Simulation of Knee Joint Replacement During a Gait Cycle Using Explicit Finite Element Analysis, Journal of Biomechanics, pp [3] Liau, J.J., Hu, C.C., Cheng, C.K., Huang, C.H., Lo, W.H., The Influence of Inserting a Fuji Pressure Sensitive Film Between the Tibiofemoral Joint of Knee Prosthesis on Actual Contact Characteristics, Clinical Biomechanics, pp [4] Jaffe, K.A., Dunham, W.K., Custom hip and knee prosthesis for limb-salvage treatment of primary bone tumors, Alabama Medicine 57, pp.11-12, [5] 聯 [6] 劉 417~435 年 [7] Gross, A.E., Revision total knee arthroplasty of bone grafts versus implant supplementation, Orthopedics 20, pp [8] Engh, G.A., Parks, N.L., The management of bone defects in revision total knee arthroplasty, Instructional Course Lectures 46, pp [9] Scott, R.D., Revision total knee arthroplasty, Clin Orthop 226, pp

121 [10] Schindler, O.S., Cannon, S.R., Briggs, T.W., Blunn, G.W., Stanmore custom-made extendible distal femoral replacements. Clinical experience in children with primary malignant bone tumours, J Bone Joint Surg 79B, pp [11] Roberts, P., Chan, D., Grimer, R.J., Sneath, R.S., Scales, J.T., Prosthetic replacement of the distal femur for primary bone tumours, J Bone Joint Surg 73B, pp [12] Eckardt, J.J., Matthews, J.G., Eilber, F.R., Endoprosthetic reconstruction after bone tumor resections of the proximal tibia, Orthop Clin N Am 22, pp [13] Barr, J.S., Eaton, R.G., Elbow reconstruction with a new prosthesis to replace the displace the distal end of the humerus. A case report, J Bone Joint Surg 47A, pp [14] Yang, R.S., Endoprosthetic reconstruction for limb salvage surgery, Biomedical Engineering-Application, Basis and Communications 10, pp [15] Yang, R.S., The application of expandable endoprosthetic reconstruction for limb salvage surgery in the skeletally immature patients, Biomedical Engineering-Application, Basis and Communications 13, pp [16] Unwin, P.S., Cobb, J.P., Walker, P.S., Distal femoral arthroplasty using custom-made prostheses. The first 218 case, J Arthroplasty 8, pp [17] Marco, V., HIDE: a new hybrid environment for the design of custom-made hip prostyhesis, Computer Methods and Programs in Biomedicine 64, pp [18] Minns, R.J., Bibb, R., The use of a reconstructed 107

122 three-dimensional solid model form CT to aid the surgical management of a total knee arthroplasty: a case study, Medical Engineering Physics 25, pp [19] 李流立論 2000 [20] Liau, J.J., Cheng, C.K., Huang, C.H., Lo, W.H., The effect of Malalignment on Stresses in Polyethylene Component of Total Knee Prostheses a Finite Element Analysis, Clinical Biomechanics, pp [21] Georg, N.D., Francesco M., Mechanical conditions in the internal stabilization of proximal tibial defects, Clinical Biomechanics 17, pp [22] Jeremy, J., Donald, L., Flat medial lateral conformity in total knee replacements does not minimize contact stresses, J. Biomechanics 35, pp [23] 利 DDH 行力立論 2003 [24] 立論 1999 [25] 立立論 2003 [26] 林立論 2004 [27] Mandell, J.A., Carter, D.R., Goodman, S.B., Schurman, D.J., A conical-collared intramedullary stem can improve stress transfer and limit micromotion, Clinical Biomechanics 19, pp

123 2004 [28] Mann, K.A., Bartel, D.L., Wright, T.M., Burstein, A.H., Coulomb frictional interfaces in modeling cemented total hipreplacements: A more realistic model, J. Biomech 28(9), pp [29] Enderle, et al., Introduction to Biomedical Engineering, Academic Press 2000 [30] 料 ASTM No.F451-99ae1 Standard Specification for Acrylic Bone Cement [31] Ericson, M.O., Nisell, R., Patellofemoral joint forces during ergometric cycling, Phys Ther., 67(9), pp [32] Perie, D., Hobatho, M.C., In vivo determination of contact areas and pressure of the femorotibial joint using non-linear finite element analysis, Clin Biomech 13, pp [33] Miyoshi, S., Takahashi, T., Analysis of the shape of the tibial tray in total knee arthroplasty using a three dimension finite element model, Clin Biomech 17, pp [34] Shelburne, K.B., Pandy, M.G., A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions, J Biomech. 30(2), pp [35] Zavatsky, A.B., O Connor, J.J. A model of human ligaments in the sagittal plane. Part 1: Response to passive flexion, Proceedings of Institution of Mechanical Engineers Part H, Journal of Engineering of Medicine 206, pp [36] Toutoungi, D.E., Zavatsky, A.B., O Connor, J.J., Parameter sensitivity of a mathematical model of the anterior cruciate ligament, Proceedings of Institution of Mechanical Engineers 109

124 Part H, Journal of Engineering of Medicine 211, pp [37] Wismans, J., Veldpaus, F., Janssen, J., Huson, A., Struben, P., A three-dimensional mathematical model of the knee-joint, Journal of Biomechanics 13, pp [38] Dalstra, M., Huiskes, R., Load transfer across the pelvic bone, J. Biomechanics 28(6), pp [39] Yang, R.S., Chen, C.C., Lung, C.Y., Yuan, J.Y., Effects of conical-collared intramedullary stem in modular hinged oncological prosthesis [40] Yang, R.S., Chen, C.C., Lung, C.Y., Hou, S.M., Biomechanical test of the anchorage device of patellar tendon in oncological prosthesis 110

125 省 66 年 5 22 歷立立林北立 a172233@gmail.com 111

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