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Xu Z, Gong X, Hu Z, Bian R, Jin Y, Li Y. Effect of novel polyethylene insert configurations on bone-implant micromotion and contact stresses in total ankle replacement prostheses: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1371851. [PMID: 38699432 PMCID: PMC11063281 DOI: 10.3389/fbioe.2024.1371851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose This study investigates the impact of elastic improvements to the artificial ankle joint insert on prosthesis biomechanics to reduce the risk of prosthesis loosening in TAR patients. Methods CT data of the right ankle was collected from one elderly female volunteer. An original TAR model (Model A) was developed from CT images and the INBONE II implant system. The development of the new inserts adopts an elastic improvement design approach, where different geometric configurations of flexible layers are inserted into the traditional insert. The structure can be divided into continuous flexible layers and intermittent flexible layers. The flexible layers aim to improve the elasticity of the component by absorbing and dispersing more kinetic energy. The newly designed inserts are used to replace the original insert in Model A, resulting in the development of Models B-D. A finite element model of gait analysis was based by gait parameters. Discrepancies in micromotion and contact behaviour were analysed during the gait cycle, along with interface fretting and articular surface stress at 50% of the gait cycle. Results In terms of micromotion, the improved elastic models showed reduced micromotion at the tibial-implant interfaces compared to the original model. The peak average micromotion decreased by 12.1%, 13.1%, and 14.5% in Models B, C, and D, respectively. The micromotion distribution also improved in the improved models, especially in Model D. Regarding contact areas, all models showed increased contact areas of articular surfaces with axial load, with Models B, C, and D increasing by 26.8%, 23.9%, and 24.4%, respectively. Contact stress on articular surfaces increased with axial load, reaching peak stress during the late stance phase. Models with continuous flexible layer designs exhibited lower stress levels. The insert and the talar prosthetic articular surfaces showed more uniform stress distribution in the improved models. Conclusion Improving the elasticity of the insert can enhance component flexibility, absorb impact forces, reduce micromotion, and improve contact behavior. The design scheme of continuous flexible layers is more advantageous in transmitting and dispersing stress, providing reference value for insert improvement.
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Affiliation(s)
- Zhi Xu
- Department of Orthopedic, Zhangjiagang Fifth People’s Hospital, Zhangjiagang, Jiangsu, China
| | - Xiaonan Gong
- Department of Orthopedic, Dongying People’s Hospital, Dongying, Shandong, China
| | - Zhengyuan Hu
- Department of Orthopedic, Jingxian Hospital, Jingxian, Anhui, China
| | - Ruixiang Bian
- Department of Orthopedic, Dongying People’s Hospital, Dongying, Shandong, China
| | - Ying Jin
- Department of Orthopedic, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yuwan Li
- Department of Orthopedic, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Druel J, Gelin N, Ollivier M, Roseren F, Chabrand P, Jacquet C, Argenson JNA. Outcomes of Short and Long Tibial Stems for Primary Total Knee Arthroplasty in a Population of Obese Patients at Two-Year Follow-Up: A Clinical and Biomechanical Study. J Arthroplasty 2024:S0883-5403(24)00146-3. [PMID: 38401608 DOI: 10.1016/j.arth.2024.02.047] [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: 11/09/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Obesity can be a source of higher failure rates and inferior clinical outcomes after total knee arthroplasty (TKA). The aim of this study was to compare outcomes, failure rates, and stress distributions of TKA in obese patients using a short, long, or no tibial stem. METHODS A matching process based on the type of stem used and the age allowed included 180 patients who had a body mass index (BMI) > 30 and underwent a TKA between January 2010 and December 2019, with a minimum follow-up of 2 years. They were classified as moderately obese (MO: 30 < BMI < 35, N = 90) and severely obese (SO: BMI > 35, N = 90). For each, 3 subgroups were defined: thirty patients received a 30 mm short stem (SS), thirty received a 100 mm long stem (LS), and thirty received no stem (NS). Patients were assessed preoperatively and postoperatively using the Knee Society Score (KSS). A finite element model was developed to evaluate the biomechanical effects of the tibial stem on stress distribution in the subchondral bone based on BMI. RESULTS The SS patients had significantly higher postoperative KSS knee score [MO: 88.9 (SS) versus 79 (LS) versus 80.6 (NS); SO: 84.5 versus 72.4 versus 78.2] (P < .0001) and function score [MO: 90.4 (SS) versus 78.4 (LS) versus 68.5 (NS); SO: 85.5 versus 73 versus 61.8] (P < .0001) compared to LS and NS patients. The biomechanical study demonstrated a BMI-dependent increase in stress in the subchondral bone in contact with the tibial components. These stresses were mainly distributed at the tibial cut for NS and along the stem for SS and LS. CONCLUSIONS A short, cemented tibial stem offers better functional outcomes without increasing failure rates compared to a longer stem during primary TKA in a population of obese patients at two-year follow-up. A short tibial stem does not lead to increased stress compared to an LS, at least for certain BMI categories.
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Affiliation(s)
- Julien Druel
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Nolwenn Gelin
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Flavy Roseren
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Patrick Chabrand
- Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Christophe Jacquet
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Jean-Noel A Argenson
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, Marseille, France; Department of Biomechanics, Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Marseille, France
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Zhang Y, Du S, Aiyiti W, Teng Y, Jia R, Jiang H. Customized design and biomechanical property analysis of 3D-printed tantalum intervertebral cages. Biomed Mater Eng 2024; 35:99-124. [PMID: 38217572 DOI: 10.3233/bme-230154] [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] [Indexed: 01/15/2024]
Abstract
BACKGROUND Intervertebral cages used in clinical applications were often general products with standard specifications, which were challenging to match with the cervical vertebra and prone to cause stress shielding and subsidence. OBJECTIVE To design and fabricate customized tantalum (Ta) intervertebral fusion cages that meets the biomechanical requirements of the cervical segment. METHODS The lattice intervertebral cages were customized designed and fabricated by the selective laser melting. The joint and muscle forces of the cervical segment under different movements were analyzed using reverse dynamics method. The stress characteristics of cage, plate, screws and vertebral endplate were analyzed by finite element analysis. The fluid flow behaviors and permeability of three lattice structures were simulated by computational fluid dynamics. Compression tests were executed to investigate the biomechanical properties of the cages. RESULTS Compared with the solid cages, the lattice-filled structures significantly reduced the stress of cages and anterior fixation system. In comparison to the octahedroid and quaddiametral lattice-filled cages, the bitriangle lattice-filled cage had a lower stress shielding rate, higher permeability, and superior subsidence resistance ability. CONCLUSION The inverse dynamics simulation combined with finite element analysis is an effective method to investigate the biomechanical properties of the cervical vertebra during movements.
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Affiliation(s)
- Yutao Zhang
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Shu Du
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Wurikaixi Aiyiti
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Yong Teng
- Department of Orthopaedics, Hospital of Xinjiang Military Region PLA, Urumqi, China
| | - Ru Jia
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
| | - Houfeng Jiang
- School of Mechanical Engineering, Xinjiang University, Urumqi, China
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Anastasio AT, Adams SB, DeOrio JK, Easley ME, Nunley JA, Lee DO. Comparison of Radiographic Talar Loosening Rates Between Salto-Talaris and INBONE II. Foot Ankle Int 2024; 45:60-66. [PMID: 37994659 DOI: 10.1177/10711007231209763] [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] [Indexed: 11/24/2023]
Abstract
BACKGROUND Despite substantial increase in total ankle arthroplasty (TAA) nationwide, there are few studies comparing flat-cut vs chamfer-cut talar systems in TAA with regard to radiographic aseptic loosening rates of the implant. METHODS This retrospective study included 189 Salto-Talaris TAA and 132 INBONE II primary TAA with a minimum 1-year follow-up. Patient characteristics were obtained including gender, age at surgery, body mass index (BMI), smoking status, primary diagnosis, surgical time, and the presence of diabetes. Radiographic evidence for aseptic loosening was assessed. Statistical analysis was performed for comparison in outcomes between Salto-Talaris and INBONE II. RESULTS The mean age of the study population was 63.5 ± 9.8 years at surgery. Mean follow-up was 4.9 ± 3.0 years. Radiographic aseptic loosening of the tibial implant showed no significant difference between the 2 groups: Salto-Talaris, 18%, and INBONE II, 18.9% (P = .829). Aseptic loosening of the talar implant also showed no significant difference between the 2 groups: Salto-Talaris, 1.6%, and INBONE II, 1.5% (P = .959). No variables, including the implant type, were found to contribute to the aseptic loosening rate of either the tibia or talus. CONCLUSION In our cohort, we observed no difference in radiographic implant aseptic loosening between Salto-Talaris and INBONE II systems. LEVEL OF EVIDENCE Level IV, retrospective case series study.
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Jyoti, Ghosh R. The role of the depth of resection of the distal tibia on biomechanical performance of the tibial component for TAR: A finite element analysis with three implant designs. Med Eng Phys 2023; 119:104034. [PMID: 37634911 DOI: 10.1016/j.medengphy.2023.104034] [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: 04/28/2023] [Revised: 07/14/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
The depth of resection of the tibia bone in total ankle replacement (TAR) may influence implant-bone micromotion and stress shielding. High implant-bone micromotion and stress-shielding lead to aseptic loosening of the tibial component for TAR. The aim was to improve the outcomes of the different designs of TAR (STAR, Mobility, and Salto) with the variation of the depth of resection of the distal tibia bone. Finite element (FE) models of the implanted tibia with the depth of resection varying from 6 mm to 16 mm and of the intact tibia was prepared. The value of micromotion increased as the depth of resection increased. The micromotion increased in the proximal anterior-posterior portion of the pegs for STAR, the posterior part of the stem for Mobility, and the proximal lateral portion of the keel for Salto with the increase in the depth of resection. Whereas, the stresses (von Mises) decreased in some regions and increased in some regions depending upon the implant design. But overall stresses decreased in the tibia bone. Furthermore, the mean stress shielding increased in all the designs as the depth of resection increased. This in silico study indicated that the depth of resection should be given more importance during TAR surgery. The ideal depth of resection should be minimum i.e., 6 mm based on this FE study.
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Affiliation(s)
- Jyoti
- School of Mechanical & Materials Engineering, Biomechanics Research Laboratory, Indian Institute of Technology Mandi, Kamand, Mandi, Himachal Pradesh 175075, India
| | - Rajesh Ghosh
- School of Mechanical & Materials Engineering, Biomechanics Research Laboratory, Indian Institute of Technology Mandi, Kamand, Mandi, Himachal Pradesh 175075, India.
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Zhang Q, Chen Z, Peng Y, Jin Z, Qin L. The novel magnesium-titanium hybrid cannulated screws for the treatment of vertical femoral neck fractures: Biomechanical evaluation. J Orthop Translat 2023; 42:127-136. [PMID: 37680903 PMCID: PMC10480783 DOI: 10.1016/j.jot.2023.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/14/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Background Conventional cannulated screws are commonly used for internal fixation in the treatment of vertical femoral neck fractures. However, the noticeably high rates of undesirable outcomes such as nonunion, malunion, avascular necrosis, and fixation failure still troubled the patients and surgeons. It is urgent to develop new cannulated screws to improve the above clinical problems. The purpose of this study was to design a novel magnesium-titanium hybrid cannulated screw and to further evaluate its biomechanical performance for the treatment of vertical femoral neck fractures. Methods A novel magnesium-titanium hybrid cannulated screw was designed, and the conventional titanium cannulated screw was also modeled. The finite element models for vertical femoral neck fractures with magnesium-titanium hybrid cannulated screws and conventional cannulated screws were respectively established. The hip joint contact force during walking gait calculated by a subject-specific musculoskeletal multibody dynamics model, was used as loads and boundary conditions for both finite element models. The stress and displacement distributions of the cannulated screws and the femur, the micromotion of the fracture surfaces of the femoral neck, and the overall stiffness were calculated and analyzed using finite element models. The biomechanical performance of the Magnesium-Titanium hybrid cannulated screws was evaluated. Results The maximum stresses of the magnesium-titanium hybrid cannulated screws and the conventional cannulated screws were 451.5 MPa and 476.8 MPa, respectively. The maximum stresses of the femur with the above different cannulated screws were 140.3 MPa and 164.8 MPa, respectively. The maximum displacement of the femur with the hybrid cannulated screws was 6.260 mm, lower than the femur with the conventional cannulated screws, which was 7.125 mm. The tangential micromotions in the two orthogonal directions at the fracture surface of the femoral neck with the magnesium-titanium hybrid cannulated screws were comparable to those with the conventional cannulated screws. The overall stiffness of the magnesium-titanium hybrid cannulated screw system was 490.17 N/mm, higher than that of the conventional cannulated screw system, which was 433.92 N/mm. Conclusion The magnesium-titanium hybrid cannulated screw had superior mechanical strength and fixation stability for the treatment of the vertical femoral neck fractures, compared with those of the conventional cannulated screw, indicating that the magnesium-titanium hybrid cannulated screw has great potential as a new fixation strategy in future clinical applications.The translational potential of this article: This study highlights an innovative design of the magnesium-titanium hybrid cannulated screw for the treatment of vertical femoral neck fractures. The novel magnesium-titanium hybrid cannulated screw not only to provide sufficient mechanical strength and fixation stability but also to contribute to the promotion of fracture healing, which could provide a better treatment for the vertical femoral neck fractures, beneficially reducing the incidence of nonunion and reoperation rates.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
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