Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, China.
Academy for Engineering and Technology, 12478Fudan University, Shanghai, China.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020966125. doi: 10.1177/2309499020966125.
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.
目的:初次全踝关节置换(TAR)后胫骨内植物松动是 TAR 术后常见的问题之一。植入物结构设计的创新可以理想地减少骨-植入物界面的微动,并增强骨-植入物固定和初始稳定性,从而最终防止长期植入物松动。本研究旨在研究(1)骨-植入物界面的生物力学特性,(2)设计特征(如半径、高度和长度)的影响。 方法:基于四种商业上可用的植入物,共创建了 101 个有限元模型。这些模型预测了骨-植入物界面的微动,并研究了结构参数(如半径、长度和高度)的影响。 结果:我们的结果表明,在植入前,柄式植入物通常需要切除最大体积的骨,而钉式植入物需要切除的最少。与中央固定特征(柄和龙骨)相比,外周分布的几何形状(杆和钉)与较低的初始微动相关。所有类型的植入物设计的初始稳定性都可以通过减小固定尺寸来优化,例如减小杆和钉的半径以及降低高度。 结论:钉式胫骨植入物设计可能是一种有前途的固定方法,它需要切除最小体积的骨,并在极端轴向加载情况下产生最小的微动。目前的模型可以作为一个有用的平台,帮助医生或工程师在相关植入物设计方面进行渐进式改进。
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