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Mitra K, Anastasio AT, Wu KA, Abar B, Schweitzer KM, Parekh SG, Easley ME, Adams SB. Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement. Foot Ankle Surg 2024:S1268-7731(24)00161-9. [PMID: 39097425 DOI: 10.1016/j.fas.2024.07.011] [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: 03/18/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Collapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations. METHODS This was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled. RESULTS A total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12-45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up. CONCLUSION These results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Kishen Mitra
- Dept. of Biomedical Engineering, Duke University, Durham, NC, United States.
| | - Albert T Anastasio
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - Kevin A Wu
- Duke University School of Medicine, Durham, NC, United States.
| | - Bijan Abar
- Duke University School of Medicine, Durham, NC, United States; Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC, United States.
| | - Karl M Schweitzer
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | | | - Mark E Easley
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - Samuel B Adams
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
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Gupta R, Grove K, Wei A, Lee J, Akkouch A. Ankle and Foot Arthroplasty and Prosthesis: A Review on the Current and Upcoming State of Designs and Manufacturing. MICROMACHINES 2023; 14:2081. [PMID: 38004938 PMCID: PMC10673427 DOI: 10.3390/mi14112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
The foot and ankle serve vital roles in weight bearing, balance, and flexibility but are susceptible to many diverse ailments, making treatment difficult. More commonly, Total Ankle Arthroplasty (TAA) and Total Talus Replacement (TTR) are used for patients with ankle degeneration and avascular necrosis of the talus, respectively. Ankle prosthesis and orthosis are also indicated for use with lower limb extremity amputations or locomotor disability, leading to the development of powered exoskeletons. However, patient outcomes remain suboptimal, commonly due to the misfitting of implants to the patient-specific anatomy. Additive manufacturing (AM) is being used to create customized, patient-specific implants and porous implant cages that provide structural support while allowing for increased bony ingrowth and to develop customized, lightweight exoskeletons with multifunctional actuators. AM implants and devices have shown success in preserving stability and mobility of the joint and achieving fast recovery, as well as significant improvements in gait rehabilitation, gait assistance, and strength for patients. This review of the literature highlights various devices and technologies currently used for foot and ankle prosthesis and orthosis with deep insight into improvements from historical technologies, manufacturing methods, and future developments in the biomedical space.
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Affiliation(s)
- Richa Gupta
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Kyra Grove
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Alice Wei
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Jennifer Lee
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Adil Akkouch
- Department of Orthopaedic Surgery and Medical Engineering Program, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA
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Sun R, Vats K, Jn Baptiste J, Adeeb S, Jomha N, Westover L. Comparison of wear on articular cartilage by titanium alloy, ultra-high-molecular-weight polyethylene, and carbon fibre reinforced polyether-ether-ketone: A pilot study. Med Eng Phys 2023; 120:104042. [PMID: 37838396 DOI: 10.1016/j.medengphy.2023.104042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 10/16/2023]
Abstract
Artificial implant materials may articulate against native articular cartilage in certain clinical scenarios and the selection of an implant material that results in the least wear on articular cartilage is preferred to maintain normal joint architecture and function. This project compared the wear on porcine femoral condyles induced by articulation against porcine patellae, titanium alloy (Ti6Al4V), ultra high molecular weight polyethylene (UHMWPE), and carbon fibre reinforced polyether-ether-ketone (CFR-PEEK) through an ex vivo experimental setup. A sinusoidal compressive load of 30-160 N, representing an approximate joint pressure of 0.19-1 MPa at a frequency of 3 Hz coupled with a rotational displacement of +/- 10⁰ at 3 Hz was used to simulate physiological joint motion. Wear was characterized via gross examination and histologically using the OARSI scoring system after 43,200 cycles. CFR-PEEK resulted in the most significant wear on articular cartilage compared to titanium alloy and UHMWPE whereas titanium alloy and UHMWPE resulted in similar levels of wear. All materials caused more wear compared to cartilage-on-cartilage testing. The wear mechanism was characterized by progressive loss of proteoglycan content in cartilage in histology samples.
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Affiliation(s)
- Ruixiang Sun
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Karan Vats
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Jonelle Jn Baptiste
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Nadr Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Lindsey Westover
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada; Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada.
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Hafez AH, El-Rich M, Liu T, Jomha N, Schiffer A. Design of a lightweight universal talus implant using topology optimization. Front Bioeng Biotechnol 2023; 11:1228809. [PMID: 37691900 PMCID: PMC10484404 DOI: 10.3389/fbioe.2023.1228809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Total talus replacement is a promising alternative treatment for talus fractures complicated by avascular necrosis and collapse. This surgical option replaces the human talus bone with a customized talus implant and can maintain ankle joint functionality compared to traditional treatment (e.g., ankle fusion). However, the customized implant is costly and time-consuming due to its customized nature. To circumvent these drawbacks, universal talus implants were proposed. While they showed clinically satisfactory results, existing talus implants are heavier than biological talus bones as they are solid inside. This can lead to unequal weight between the implant and biological talus bone, and therefore leading to other complications. The reduction of the implants' weight without compromising its performance and congruency with surrounding bones is a potential solution. Therefore, this study aims to design a lightweight universal talus implant using topology optimization. This is done through establishing the loading and boundary conditions for three common foot postures: neutral, dorsi- and plantar-flexion. The optimized implant performance in terms of mass, contact characteristics with surrounding joint cartilage and stress distributions is studied using a 3D Finite Element (FE) model of the ankle joint. The mass of the optimized implant is reduced by approximately 66.6% and its maximum stresses do not exceed 70 MPa, resulting in a safety factor of 15.7. Moreover, the optimized and solid implants show similar contact characteristics. Both implants produced peak contact pressures that were approximately 19.0%-196% higher than those produced by the biological talus. While further mechanical testing under in-vivo loading conditions is required to determine clinical feasibility, preliminarily, the use of a lightweight universal implant is expected to provide the patient with a more natural feel, and a reduced waiting period until surgery.
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Affiliation(s)
- Ahmed H. Hafez
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Tao Liu
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Nadr Jomha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andreas Schiffer
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
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Johnson LG, Anastasio AT, Fletcher AN, Hendren S, Adams SB. Outcomes following total talus replacement: A systematic review. Foot Ankle Surg 2022; 28:1194-1201. [PMID: 36028440 DOI: 10.1016/j.fas.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/30/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The treatment of pathologic changes to the talus and surrounding joints presents a unique challenge to the foot and ankle surgeon. The purpose of this systematic review is to summarize the literature for unconstrained (no surrounding fusion or replacement) total talus replacement (TTR) and evaluate whether it leads to improved clinical and radiographic outcomes and appropriate safety metrics. METHODS Concepts of talus and arthroplasty were searched in MEDLINE, Embase, CINAHL Complete, and Scopus from 2005 to 2021. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic or degenerative arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, and 5) inflammatory arthropathy to tibiotalar joint. Manuscripts in non-English languages or those with concomitant total ankle arthroplasty or revision arthroplasty were excluded. RESULTS Twenty-two studies of 191 patients (196 ankles) were included. Nineteen studies utilized third generation implants, two studies used first generation (n = 9) and one study used second generation implants (n = 14) made largely of ceramic (n = 84), cobalt chrome (n = 49), or titanium (n = 24). Patient-reported outcome measures were favorable in all described categories (Table 4) with ten studies reporting an average postoperative change of + 2.92° of dorsiflexion and - 2.05° plantarflexion at final follow-up. The most common adverse outcome was adjacent joint arthritis with five studies reporting some degree of postoperative, degenerative changes in the surrounding joints (n = 52). CONCLUSION TTR is an alternative to joint sacrificing procedures to maintain range of motion through the tibiotalar joint and allow for maintenance of normal foot and ankle biomechanics. Despite promising early- and mid-term outcomes, future, prospective, randomized research should be conducted to better assess survivorship and complication rates with direct comparison of TTR to existing forms of salvage options for advanced talar pathology. LEVEL OF EVIDENCE III, Systematic Review of Level IV Studies.
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Affiliation(s)
- Lindsey G Johnson
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | | | | | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Vafaeian B, Riahi HT, Amoushahi H, Jomha NM, Adeeb S. A feature-based statistical shape model for geometric analysis of the human talus and development of universal talar prostheses. J Anat 2022; 240:305-322. [PMID: 34549428 PMCID: PMC8742977 DOI: 10.1111/joa.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
Statistical data pertaining to anatomic variations of the human talus contain valuable information for advances in biological anthropology, diagnosis of the talar pathologies, and designing talar prostheses. A statistical shape model (SSM) can be a powerful data analysis tool for the anatomic variations of the talus. The main concern in constructing an SSM for the talus is establishing the true geometric correspondence between the talar geometries. The true correspondence complies with biological and/or mathematical homologies on the talar surfaces. In this study, we proposed a semi-automatic approach to establish a dense correspondence between talar surfaces discretized by triangular meshes. Through our approach, homologous salient surface features in the form of crest lines were detected on 49 talar surfaces. Then, the point-wise correspondence information of the crest lines was recruited to create posterior Gaussian process morphable models that non-rigidly registered the talar meshes and consequently established inter-mesh dense correspondence. The resultant correspondence perceptually represented the true correspondence as per our visual assessments. Having established the correspondence, we computed the mean shape using full generalized Procrustes analysis and constructed an SSM by means of principal component analysis. Anatomical variations and the mean shape of the talus were predicted by the SSM. As a clinically related application, we considered the mean shape and investigated the feasibility of designing universal talar prostheses. Our results suggest that the mean shape of (the shapes of) tali can be used as a scalable shape template for designing universal talar prostheses.
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Affiliation(s)
- Behzad Vafaeian
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Hossein Tajmir Riahi
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Hossein Amoushahi
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Nadr M. Jomha
- Division of Orthopaedic SurgeryDepartment of SurgeryUniversity of AlbertaEdmontonABCanada
| | - Samer Adeeb
- Department of Civil and Environmental EngineeringUniversity of AlbertaEdmontonABCanada
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7
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Liu T, Ead M, Cruz SDV, Jomha N, Adeeb S, El-Rich M, Duke K, Westover L. Polycarbonate-urethane coating can significantly improve talus implant contact characteristics. J Mech Behav Biomed Mater 2021; 125:104936. [PMID: 34749205 DOI: 10.1016/j.jmbbm.2021.104936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
Talus implants can be utilized in cases of talus avascular necrosis and has been regarded as a promising treatment method. However, existing implants are made of stiff materials that directly oppose natural cartilage. The risk of long-term cartilage wear and bone fracture from the interaction between the cartilage and stiff implant surfaces has been documented in post-hemiarthroplasty of the hip, knee and ankle joints. The aim is to explore the effects of adding a layer of compliant material (polycarbonate-urethane; PCU) over a stiff material (cobalt chromium) in talus implants. To do so, we obtained initial ankle geometry from four cadaveric subjects in neutral standing to create the finite element models. We simulated seven models for each subject: three different types of talus implants, each coated with and without PCU, and a biological model. In total, we constructed 28 finite element models. By comparing the contact characteristics of the implant models with their respective biological model counterparts, our results showed that PCU coated implants have comparable contact area and contact pressure to the biological models, whereas stiff material implants without the PCU coating all have relatively higher contact pressure and smaller contact areas. These results confirmed that adding a layer of compliant material coating reduces the contact pressure and increases the contact area which in turn reduces the risk of cartilage wear and bone fracture. The results also suggest that there can be clinical benefits of adding a layer of compliant material coating on existing stiff material implants, and can provide valuable information towards the design of more biofidelic implants in the future.
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Affiliation(s)
- Tao Liu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Maha Ead
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Shaira D V Cruz
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr Jomha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kajsa Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Dimitrov AS, Westover L, Jomha NM. Clinical Use of Talar Prostheses. JBJS Rev 2021; 9:01874474-202106000-00004. [PMID: 34101700 DOI: 10.2106/jbjs.rvw.20.00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The blood supply to the talus is vulnerable to damage, making the talus susceptible to osteonecrosis, with limited treatment options. » Talar bone replacement has been investigated as a treatment option to preserve ankle function and maintain limb length. » Successful talar bone replacements have been performed for the past >35 years, with variations in design, methods of fixation, materials, and manufacturing techniques. » The designs of talar prostheses range from custom-made partial (talar body) or total prostheses to prefabricated universal (non-custom-made) prostheses. » Total talar prostheses have been demonstrated to function better than partial talar prostheses; however, there is a need for long-term studies regarding custom-made total talar prostheses and prefabricated universal talar prostheses in order to determine their long-term effectiveness.
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Affiliation(s)
- Andrea S Dimitrov
- School of Medicine, College of Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Mu MD, Yang QD, Chen W, Tao X, Zhang CK, Zhang X, Xie MM, Tang KL. Three dimension printing talar prostheses for total replacement in talar necrosis and collapse. INTERNATIONAL ORTHOPAEDICS 2021; 45:2313-2321. [PMID: 33666766 PMCID: PMC8494653 DOI: 10.1007/s00264-021-04992-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
Background Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. Methods Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. Results After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI − 13.05 to − 0.87, t = 2.94, P = 0.032) and Meary’s angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. Conclusions The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.
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Affiliation(s)
- Mi Duo Mu
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Qian Dong Yang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Wan Chen
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Xu Tao
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Cheng Ke Zhang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Xuan Zhang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Mei Ming Xie
- The General Hospital of Western Theater Command, Chengdu, China.
| | - Kang Lai Tang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China.
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Liu T, Jomha NM, Adeeb S, El-Rich M, Westover L. Investigation of the Average Shape and Principal Variations of the Human Talus Bone Using Statistic Shape Model. Front Bioeng Biotechnol 2020; 8:656. [PMID: 32714904 PMCID: PMC7351508 DOI: 10.3389/fbioe.2020.00656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the complexity of articular interconnections and tenuous blood supply to the talus, talus fractures are often associated with complications (e.g., avascular necrosis). Currently, surgically fusing the talus to adjacent bones is widely used as treatment to talus fractures, but this procedure can greatly reduce mobility in the ankle and hindfoot. Alternatively, customized talus implants have shown an overall satisfactory patient feedback but with the limitation of high expenses and time-consuming manufacturing process. In order to circumvent these disadvantages, universal talus implants have been proposed as a potential solution. In our study, we aimed to develop a methodology using Statistical Shape Model (SSM) to simulate the talus, and then evaluate the feasibility of the model to obtain the mean shape needed for universal implant design. In order to achieve this, we registered 98 tali (41 females and 57 males) and used the registered dataset to train our SSM. We used the mean shape derived from the SSM as the basis for our talus implant template, and compared our template with that of previous works. We found that our SSM mean shape talus implant was geometrically similar to implants from other works, which used a different method for the mean shape. This suggests the feasibility of SSM as a method of finding mean shape information for the development of universal implants. A second aim of our study was to investigate if one scalable talus implant can accommodate all patients. In our study, we focused on addressing this from a geometric perspective as there are multiple factors impacting this (e.g., articular surface contact characteristics, implant material properties). Our initial findings are that the first two principal components should be afforded consideration for the geometrical accuracy of talus implant design. Additional factors would need to be further evaluated for their role in informing universal talus implant design.
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Affiliation(s)
- Tao Liu
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.,Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
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