Osseointegration of prostheses on the stapes footplate: evaluation of the biomechanical feasibility by using a finite element model.

Restoration of hearing is one of the main issues of tympanoplasty. Depending on the extent of destruction, the ossicular chain is partially or totally replaced by prostheses. In the unfavorable event of complete ossicular chain destruction with only the stapes footplate remaining in the oval niche, implanting of a columella prosthesis represents the gold standard. Besides ventilation problems, the main causes of unsatisfactory hearing results are dislocation of the prosthesis and poor coupling to the footplate. Therefore, stable fixation of prostheses is desirable but has not been realized to date. In line with our experimental intention to realize a bony prosthesis fixation on the footplate, we designed a finite element model for the simulation of the interacting forces once an osseointegration was achieved. These preliminary results predict the mechanical feasibility of this endeavor and the necessary general preconditions, which have to be carefully considered. A specially designed titanium prosthesis anchor needs a minimal bony fixation of 104 microm accretion height on the footplate to withstand all emerging forces. Therefore, providing a sort of artificial stapedial suprastructure in the form of a firm, preferably bony, integration of a prosthesis anchor on the footplate seems to be realistic and worthwhile from a mechanical and medical point of view.