Finite-element analysis of the influence of tibial implant fixation design of total ankle replacement on bone-implant interfacial biomechanical performance

PURPOSE

Implant loosening in tibia after primary total ankle replacement (TAR) is one of the common postoperative problems in TAR. Innovations in implant structure design may ideally reduce micromotion at the bone-implant interface and enhance the bone-implant fixation and initial stability, thus eventually prevents long-term implant loosening. This study aimed to investigate (1) biomechanical characteristics at the bone-implant interface and (2) the influence of design features, such as radius, height, and length.

METHODS

A total of 101 finite-element models were created based on four commercially available implants. The models predicted micromotion at the bone-implant interface, and we investigated the impact of structural parameters, such as radius, length, and height.

RESULTS

Our results suggested that stem-type implants generally required the highest volume of bone resection before implantation, while peg-type implants required the lowest. Compared with central fixation features (stem and keel), peripherally distributed geometries (bar and peg) were associated with lower initial micromotions. The initial stability of all types of implant design can be optimized by decreasing fixation size, such as reducing the radius of the bars and pegs and lowering the height.

CONCLUSION

Peg-type tibial implant design may be a promising fixation method, which is required with a minimum bone resection volume and yielded minimum micromotion under an extreme axial loading scenario. Present models can serve as a useful platform to build upon to help physicians or engineers when making incremental improvements related to implant design.

Mathematical Development of a Novel Discrete Hip Deformation Algorithm for the In Silico Elasto-Hydrodynamic Lubrication Modelling of Total Hip Replacements

In this paper, the procedure to achieve an accurate deformation model of a total hip replacement (THR) was proposed with the aim to obtain a numerical tool to be simply merged into THR elasto-hydrodynamic computational synovial lubrication algorithms. The approach was based on the Finite Element Method (FEM) and was developed in a Matlab code, allowing the definition of the influence matrix and of a boundary conditions vector. It works with linear tetrahedra and performs the displacement calculation for both the acetabular cup and the femoral head, taking into account the anatomical hip relative motion, by coupling them with a cubic interpolation matrix. Two simulations were conducted in order to validate the algorithm and the results were compared with the ones obtained by the commercial software Ansys. The comparison provides a satisfactory agreement in terms of surface deformation, Von Mises stress and strain energy, proving the reliability of the model and the possibility to use the model in the in silico prostheses tribological simulations, avoiding the complexity and the high computational resource requirement coming from the coupling between complex lubrication algorithms and FEM commercial software, and with the possibility to directly act on many key parameter characteristics of the investigated problem.

Effect of Ligament Properties on Nonlinear Dynamics and Wear Prediction of Knee Prostheses

Although wear is known as the primary cause of long-time failure of total knee arthroplasty (TKA), it can be vital in short- and midterm TKA failure due to laxity. One of the reasons leading to joint laxity and instability is ligamentous insufficiency. This study, therefore, aims to investigate the effects of insufficient ligaments-related knee laxity on both nonlinear dynamics and wear of TKA. The study hypothesizes (a) ligamentous insufficiency can increase TKA damage; (b) stiffness reduction of each of the posterior cruciate ligament (PCL) and medial-lateral collateral ligaments (MCL-LCL) can differently contribute to TKA damage. A forward dynamics methodology is developed and the ligament behavior is simulated employing an asymmetric nonlinear elastic model. External loads and moment, due to the presence of all soft tissues, e.g., muscles and hip joint reaction forces, applied to the femoral bone are determined using a musculoskeletal approach linked to the developed model. A mesh density analysis is performed and comparing outcomes with that available in the literature allows for the assessment of our approach. From the results acquired, reduced PCL stiffness leads to an increase in linear wear rates and results in the maximum damage in TKAs. However, the maximum linear wear rates on both condyles occur once the stiffness of all ligaments is reduced. Moreover, the worn area of the tibia surface increases with the reduction in MCL-LCL stiffness on the medial condyle. The joint with insufficient PCL also shows a considerable increase in ligament forces right after toe-off.