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Terrill P, Patel R, Pacaccio D, Dupont K, Safranski D, Yakacki C, Carpenter D. Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: A patient-specific finite element study. PLoS One 2023; 18:e0288049. [PMID: 37972050 PMCID: PMC10653524 DOI: 10.1371/journal.pone.0288049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/16/2023] [Indexed: 11/19/2023] Open
Abstract
Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption.
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Affiliation(s)
- Patrick Terrill
- Smart Materials and Biomechanics Laboratory, Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado, United States of America
| | - Ravi Patel
- Smart Materials and Biomechanics Laboratory, Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado, United States of America
| | - Douglas Pacaccio
- Advanced Foot and Ankle Surgeons Incorporated, Yorkville, Illinois, United States of America
| | - Kenneth Dupont
- Clinical Affairs, Foot & Ankle, Enovis, Atlanta, Georgia, United States of America
| | - David Safranski
- Clinical Affairs, Foot & Ankle, Enovis, Atlanta, Georgia, United States of America
| | - Christopher Yakacki
- Smart Materials and Biomechanics Laboratory, Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado, United States of America
| | - Dana Carpenter
- Smart Materials and Biomechanics Laboratory, Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado, United States of America
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Beals CJ, Dupont KM, Gross CE, Safranski DL. Effect of Arthrodesis Device Type and Trajectory on Subtalar Joint Compression. J Foot Ankle Surg 2023; 62:812-815. [PMID: 37088274 DOI: 10.1053/j.jfas.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
The use of subtalar arthrodesis procedures has been widely implemented to relieve hindfoot issues after failure of conservative treatments; however, fusion failures persist in some patients with certain risk factors. Currently, surgeons utilize cannulated screws in these arthrodesis procedures to immobilize the subtalar joint. Recent clinical studies have demonstrated improved fusion outcomes in at-risk patients using sustained dynamic compression devices in the tibiotalocalcaneal complex. These devices utilize pseudoelastic nitinol which enables sustained dynamic compression when faced with postoperative bone resorption, joint settling, and bone relaxation. While the clinical success of these devices has been established in the tibiotalocalcaneal complex, the ability of sustained dynamic compression devices to apply joint compression in the subtalar joint has not been quantified. As such, the goals of this study were to (1) compare the ability of static compression devices and sustained dynamic compression devices to apply joint compression and (2) assess the impact of device trajectory on joint compression. A custom mechanical testing fixture was utilized to test the compression applied across the subtalar joint by one sustained dynamic compression device (in anterior and posterior trajectories) as compared to 2 cannulated screws (in both parallel and diverging trajectories). Testing revealed the sustained dynamic compression devices generated 53% greater compression as compared to the static compression devices, despite single versus dual device usage, respectively. Additionally, both types of devices applied joint compression forces in an insertion trajectory-independent manner. These data illustrate the ability of a single SDC device to maintain significantly improved joint compressive forces as compared to 2 static cannulated screws, regardless of insertion trajectory. These SDC devices may be of particular interest for at-risk patients or in revision cases.
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Affiliation(s)
- Caitlyn J Beals
- Engineering Student, W. H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - Christopher E Gross
- Associate Professor, Director of Foot & Ankle Division, Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - David L Safranski
- Research Leader, Enovis Foot & Ankle, Clinical Affairs, Atlanta, GA; Adjunct Assistant Professor, School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA.
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Beals CJ, Wong GAS, Dupont KM, Safranski DL. Effect of Simulated Bone Resorption on the Biomechanical Performance of Intramedullary Devices for Foot and Ankle Arthrodesis. J Foot Ankle Surg 2022; 62:7-13. [PMID: 35370055 DOI: 10.1053/j.jfas.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
Midfoot and subtalar arthrodesis surgeries are performed to correct foot deformities and relieve arthritic pain. These procedures often employ intramedullary (IM) devices. The aim of the present study was to evaluate the biomechanical performance of a sustained dynamic compression (SDC) IM device compared to mechanically static devices in withstanding the effects of simulated bone resorption. Mechanically static and SDC IM devices were implanted in simulated bone blocks (n = 5/device). Compressive loads were measured with a custom-made mechanism to simulate bone resorption. The construct bending stiffness was determined from a 4-point bend test. Resorption was simulated by cutting a 1 mm or 2 mm gap in the midpoint of each construct and repeating the loading (n = 6/device). Initial compressive loads after device insertion were greater in the SDC IM devices when compared to the static devices (p < .01). The SDC device was able to sustain compression from 2 mm to 5.5 mm of simulated resorption depending upon device length, while the static devices lost compression within 1 mm of simulated resorption regardless of implant length (p < .001). In the 4-point bend test, the SDC device maintained its bending stiffness during simulated resorption whereas the static device displayed a significant loss in bending stiffness after 1 mm of simulated resorption (p < .001). The SDC device exhibited a significantly higher bending stiffness than the static device (p < .001). The SDC IM device demonstrated superior biomechanical performance during simulated resorption compared to static devices (p < .001). In conclusion, the ability of SDC IM devices to maintain construct stability and sustain compression across the fusion site while adapting to bone resorption may lead to greater fusion rates and overall quicker times to fusion than static IM devices. Surgeons who perform midfoot and subtalar arthrodesis procedures should be aware of a device's ability to sustain compression, especially in cases where bone resorption and joint settling are prevalent postoperatively.
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Affiliation(s)
- Caitlyn J Beals
- Engineering Student, Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Gabriella A S Wong
- Engineering Student, Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - David L Safranski
- Research Leader, Clinical Affairs, Foot & Ankle, Atlanta, GA; School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA.
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Alsayel F, Alttahir M, Wiewiorski M, Barg A, Herrera M, Valderrabano V. Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00053. [PMID: 33914712 DOI: 10.2106/jbjs.cc.20.00339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA). CONCLUSION The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.
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Affiliation(s)
- Faisal Alsayel
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mustafa Alttahir
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia
| | - Martin Wiewiorski
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Alexej Barg
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Mario Herrera
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
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