Total ankle replacement design and positioning affect implant-bone micromotion and bone strains

Sopher, Ran; Amis, Andrew A.; Calder, James D.; Jeffers, Jonathan R.T.

doi:10.1016/j.medengphy.2017.01.022

Cited by 73 publications

(76 citation statements)

References 49 publications

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“…The FE predicted bone strain and bone‐prosthesis interface micromotion results have shown a good correlation with the strain and interface micromotion values measured by in vitro cadaveric study, indicating the validity of the FE models generated and can be used for reliable TAR biomechanical study. The overall principal strains obtained in this study were well below the bone yield strains of 0.73% (−7300 με) (minimum principal strain) and 0.65% (6500 με) (maximum principal strain) . Potentially, the new PD Design (contralateral talus bone left) induced experimental and predicted principal strains that were essentially lower than the STAR Ankle talar component.…”

Section: Discussionmentioning

confidence: 59%

“…Thus, this study is important to understand the relative micromotion and minimum principal stress issues of the TAR with the scope of reducing the aseptic loosening risk. Results from this study have shown that the relative micromotion and minimum principal stress were greatly influenced by the complexity of the talar component design, loading conditions, and the gait cycles due to the meniscal bearing displacements compressing both the talar component and talus bone. This can be clearly seen from the contour plot results as shown in the Figure (BPIRM) and Figure (minimum principal stress).…”

Section: Discussionmentioning

confidence: 96%

“…The overall principal strains obtained in this study were well below the bone yield strains of 0.73% (−7300 με) (minimum principal strain) and 0.65% (6500 με) (maximum principal strain). 25,40 Potentially, the new PD Design (contralateral talus bone left) induced experimental and predicted principal strains that were essentially lower than the STAR Ankle talar component. Primary stability can be quantified through the bone-prosthesis relative micromotion and is critically important in preventing the implant aseptic loosening 11,12,14,18 as well as long-term survivability.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of biomechanics and finite element (FE) studies for the TAR especially on the talar component aseptic loosening in regards to bone‐prosthesis interface relative micromotion (BPIRM) . FE modelling is a common approach for investigating the biomechanical responses such as displacement (micromotion), stress, and strains on specific locations for the bone‐prosthesis regions upon implantation . In addition, FE modelling allows parametric analysis of the design features to be conducted so that an optimal design could be obtained.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Finite element analysis of bone‐prosthesis interface micromotion for cementless talar component fixation through critical loading conditions

Moideen

Lim

Yeow

et al. 2020

Numer Methods Biomed Eng

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The total ankle replacement (TAR) survivability rate is still suboptimal, and this leads to many orthopaedic surgeons opting arthrodesis as a better option for the ankle arthritis patients. One of the fundamental reasons is due to the lack of primary stability of the prosthesis fixation at the bone‐prosthesis interface hence leading to long‐term aseptic loosening of the talar component. The commercially available Scandinavian Total Ankle Replacement (STAR) Ankle design and several additional design features (including trabecular metal, side fin, double fin, and polka‐dot designs) were studied using finite element analysis, and the bone‐prosthesis interface relative micromotion (BPIRM) and talar bone minimum principal stresses were examined and analysed. Three loading conditions at a gait cycle of heel strike, midstance, and toe off with different meniscal bearing displacement were also included as part of the study parameters. The results were correlated to in vitro cadaveric measurements and reported clinical studies. Simulated results showed that the de‐bonding relative distance between the bone and prosthesis upon loading (COPEN defined by the simulation software) was the main reason constituting to the high interface micromotion between the talar component and talus bone (which could lead to long‐term aseptic loosening). The polka‐dot design was shown to induce the lowest BPIRM among all the designs studied.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Finite element analysis of bone‐prosthesis interface micromotion for cementless talar component fixation through critical loading conditions

Moideen

Lim

Yeow

et al. 2020

Numer Methods Biomed Eng

View full text Add to dashboard Cite

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“…Proper implant positioning is mandatory for achieving good clinical results in TAA [8,21,22]. Compared with total hip and knee, the ankle joint presents a smaller surface area for load transmission and may withstand up to 500% of body weight during level walking [23].…”

Section: Discussionmentioning

confidence: 99%

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

et al. 2020

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Background: Computer navigation and patient-specific instrumentation for total ankle arthroplasty have still to demonstrate their theoretical ability to improve implant positioning and functional outcomes. The purpose of this paper is to present a new and complete total ankle arthroplasty customization process for severe posttraumatic ankle joint arthritis, consisting of patient-specific 3D-printed implant and instrumentation, starting from a ligament-compatible design. Case presentation: The new customization process was proposed in a 57-year-old male patient and involved image analysis, joint modeling, prosthesis design, patient-specific implant and instrumentation development, relevant prototyping, manufacturing, and implantation. Images obtained from a CT scan were processed for a 3D model of the ankle, and the BOX ankle prosthesis (MatOrtho, UK) geometries were customized to best fit the model. Virtual in silico, i.e., at the computer, implantation was performed to optimize positioning of these components. Corresponding patient-specific cutting guides for bone preparation were designed. The obtained models were printed in ABS by additive manufacturing for a final check. Once the planning procedure was approved, the models were sent to final state-of-the-art additive manufacturing (the metal components using cobalt-chromium-molybdenum powders, and the guides using polyamide). The custom-made prosthesis was then implanted using the cutting guides. The design, manufacturing, and implantation procedures were completed successfully and consistently, and final dimensions and location for the implant corresponded with the preoperative plan. Immediate post-op X-rays showed good implant positioning and alignment. After 4 months, clinical scores and functional abilities were excellent. Gait analysis showed satisfactory joint moment at the ankle complex and muscle activation timing within normality. Conclusions: The complete customization process for total ankle arthroplasty provided accurate and reliable implant positioning, with satisfactory short-term clinical outcomes. However, further studies are needed to confirm the potential benefits of this complete customization process. Level of evidence: 5. Case report.

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Total ankle replacement along with subtalar joint arthrodesis: In‐vitro and in‐silico biomechanical investigations

Taghizadeh

Chitsazan

Pezeshki

et al. 2021

Numer Methods Biomed Eng

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Total ankle replacement (TAR) and subtalar joint (STJ) fusion, are popular treatments for ankle osteoarthritis (OA). Short endurance limits the former, and movement disability comes with the latter. It is hypothesized here that fusion of the STJ can improve the longevity of the TAR prosthesis. In this study, a fresh human cadaver's ankle joint underwent TAR surgery, and strain patterns in the vicinity of prosthesis were recorded after the application of axial compressive load on tibia, resembling stance phase of the gait. Then, STJ of the same sample fused (FTAR), and a similar test procedure was pursued. The obtained strains in the FTAR were smaller than those of the TAR (p < .01). Finite element models of the tested samples were also made, and validated by experimental strains. The validated FE models were then employed to find stress distribution on the tibial plateau and prosthesis compartments. FTAR demonstrated more regular stress profiles in bone‐prosthesis interface. Also, maximum von Mises stress in the talar component of the FTAR is approximately half of that in the TAR (8 and 15 MPa, respectively). Based on the results of this study, having a more symmetric load distribution on the prosthesis after STJ fusion, longevity of the TAR may likely increase.

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Total ankle replacement design and positioning affect implant-bone micromotion and bone strains

Cited by 73 publications

References 49 publications

Finite element analysis of bone‐prosthesis interface micromotion for cementless talar component fixation through critical loading conditions

Finite element analysis of bone‐prosthesis interface micromotion for cementless talar component fixation through critical loading conditions

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

Total ankle replacement along with subtalar joint arthrodesis: In‐vitro and in‐silico biomechanical investigations

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