Computational evaluation of psoas muscle influence on walking function following internal hemipelvectomy with reconstruction.

Autor:	Vega MM; Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States., Li G; Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States., Shourijeh MS; Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States., Ao D; Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States., Weinschenk RC; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States., Patten C; Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, UC Davis School of Medicine, Sacramento, CA, United States.; UC Davis Center for Neuroengineering and Medicine, University of California, Davis, CA, United States.; VA Northern California Health Care System, Martinez, CA, United States., Font-Llagunes JM; Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain.; Health Technologies and Innovation, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain., Lewis VO; Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States., Fregly BJ; Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in bioengineering and biotechnology [Front Bioeng Biotechnol] 2022 Sep 28; Vol. 10, pp. 855870. Date of Electronic Publication: 2022 Sep 28 (Print Publication: 2022).
DOI:	10.3389/fbioe.2022.855870
Abstrakt:	An emerging option for internal hemipelvectomy surgery is custom prosthesis reconstruction. This option typically recapitulates the resected pelvic bony anatomy with the goal of maximizing post-surgery walking function while minimizing recovery time. However, the current custom prosthesis design process does not account for the patient's post-surgery prosthesis and bone loading patterns, nor can it predict how different surgical or rehabilitation decisions (e.g., retention or removal of the psoas muscle, strengthening the psoas) will affect prosthesis durability and post-surgery walking function. These factors may contribute to the high observed failure rate for custom pelvic prostheses, discouraging orthopedic oncologists from pursuing this valuable treatment option. One possibility for addressing this problem is to simulate the complex interaction between surgical and rehabilitation decisions, post-surgery walking function, and custom pelvic prosthesis design using patient-specific neuromusculoskeletal models. As a first step toward developing this capability, this study used a personalized neuromusculoskeletal model and direct collocation optimal control to predict the impact of ipsilateral psoas muscle strength on walking function following internal hemipelvectomy with custom prosthesis reconstruction. The influence of the psoas muscle was targeted since retention of this important muscle can be surgically demanding for certain tumors, requiring additional time in the operating room. The post-surgery walking predictions emulated the most common surgical scenario encountered at MD Anderson Cancer Center in Houston. Simulated post-surgery psoas strengths included 0% (removed), 50% (weakened), 100% (maintained), and 150% (strengthened) of the pre-surgery value. However, only the 100% and 150% cases successfully converged to a complete gait cycle. When post-surgery psoas strength was maintained, clinical gait features were predicted, including increased stance width, decreased stride length, and increased lumbar bending towards the operated side. Furthermore, when post-surgery psoas strength was increased, stance width and stride length returned to pre-surgery values. These results suggest that retention and strengthening of the psoas muscle on the operated side may be important for maximizing post-surgery walking function. If future studies can validate this computational approach using post-surgery experimental walking data, the approach may eventually influence surgical, rehabilitation, and custom prosthesis design decisions to meet the unique clinical needs of pelvic sarcoma patients. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Vega, Li, Shourijeh, Ao, Weinschenk, Patten, Font-Llagunes, Lewis and Fregly.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu