Experimental and finite element investigation of total ankle replacement: A review of literature and recommendations.
Ontology highlight
ABSTRACT:
SUBMITTER: Mondal S
PROVIDER: S-EPMC7068038 | biostudies-literature | 2020 Mar-Apr
REPOSITORIES: biostudies-literature
Publications
Experimental and finite element investigation of total ankle replacement: A review of literature and recommendations.
Mondal Subrata S Ghosh Rajesh R
Journal of orthopaedics 20190911
This paper briefly reviews the different methodology, technology, challenges, and outcomes of various studies related to TAR prosthesis based on numerical and experimental techniques. Very less in-vitro experimental studies on TAR have been found than finite element (FE) studies. Due to the invasive nature of the experimental approach, inadequacy and less clinical information, computational modelling has been widely used by the researchers. This paper critically examines the part related to FE m ...[more]
Similar Datasets
Project description:BackgroundA proper combination of implant materials for Total Ankle Replacement (TAR) may reduce stress at the bearing component and the resected surfaces of the tibia and talus, thus avoiding implant failure of the bearing component or aseptic loosening at the bone-implant interface.MethodsA comprehensive finite element foot model implanted with the INBONE II implant system was created and the loading at the second peak of ground reaction force was simulated. Twelve material combinations including four materials for tibial and talar components (Ceramic, CoCrMo, Ti6Al4V, CFR-PEEK) and three materials for bearing components (CFR-PEEK, PEEK, and UHMWPE) were analyzed. Von Mises stress at the top and articular surfaces of the bearing component and the resected surfaces of the tibia and talus were recorded.ResultsThe stress at both the top and articular surfaces of the bearing component could be greatly reduced with more compliant bearing materials (44.76 to 72.77% difference of peak stress value), and to a lesser extent with more compliant materials for the tibial and talar components (0.94 to 28.09% difference of peak stress value). Peak stresses at both the tibial and talar bone-implant interface could be reduced more strongly by using tibial and talar component materials with smaller material stiffness (7.31 to 66.95% difference of peak stress value) compared with bearing materials with smaller material stiffness (1.11 to 24.77% difference of peak stress value).ConclusionsImplant components with smaller material stiffness provided a stress reduction at the bearing component and resected surfaces of the tibia and talus. The selection of CFR-PEEK as the material of tibial and talar components and UHMWPE as the material of the bearing component seemed to be a promising material combination for TAR implants. Wear testing and long-term failure analysis of TAR implants with these materials should be included in future studies.
| S-EPMC8772082 | biostudies-literature
Project description:BackgroundThe posteromedial ankle structures are at risk during total ankle replacement (TAR). The purpose of our study was to investigate the distance of these structures from the posterior cortex of the tibia and talus in order to determine their anatomy at different levels of bone resection during a TAR and whether plantarflexion of the ankle reliably moved these structures posteriorly.MethodsTen feet in 10 patients with end-stage tibiotalar arthritis indicated for a TAR were included. Preoperative magnetic resonance images were obtained with the foot in a neutral position as well as in maximum plantarflexion to measure the distance of posteromedial ankle structures to the closest part of the posterior cortex of the tibia or talus. Wilcoxon signed-rank rests were used to investigate differences in these distances.ResultsThe mean distance from the posterior tibial cortex to the tibial nerve at 14 and 7 mm above the tibial plafond was 8.7 mm (range 5.0-11.8 mm) and 6.7 mm (range 2.7-10.6 mm), respectively, which represented a statistically significant movement anteriorly (P = .021). The posterior tibial artery was, on average, 8.0 mm (range 3.6-13.9 mm) and 7.2 mm (range 3.1-9.4 mm) from the posterior tibial cortex at 14 and 7 mm above the tibial plafond, respectively. Distal to the tibial plafond, the posterior tibial artery and flexor digitorum longus tendons moved posteriorly by less than 1 mm in plantarflexion (all P < .05); otherwise, plantarflexion of the ankle did not affect the position of the tibial nerve, posterior tibial tendon, or flexor hallucis longus.ConclusionIn patients with end-stage ankle arthritis, the tibial nerve and posterior tibial artery lie, on average, between 6.5 and 10 mm from the posterior tibial and talar cortices. Plantarflexion of the ankle did not reliably move the posteromedial ankle structures posteriorly.Level of evidenceLevel IV, case series, therapeutic.
| S-EPMC8697152 | biostudies-literature
Project description:Patients with bone metastases have an increased risk to sustain a pathological fracture as lytic metastatic lesions damage and weaken the bone. In order to prevent fractures, prophylactic treatment is advised for patients with a high fracture risk. Mechanical stabilization of the femur can be provided through femoroplasty, a minimally invasive procedure where bone cement is injected into the lesion, or through internal fixation with intra- or extramedullary implants. Clinicians face the task of determining whether or not prophylactic treatment is required and which treatment would be the most optimal. Finite element (FE) models are promising tools that could support this decision process. The aim of this paper is to provide an overview of the state-of-the-art in FE modeling for the treatment decision of metastatic bone lesions in the femur. First, we will summarize the clinical and mechanical results of femoroplasty as a prophylactic treatment method. Secondly, current FE models for fracture risk assessment of metastatic femurs will be reviewed and the remaining challenges for clinical implementation will be discussed. Thirdly, we will elaborate on the simulation of femoroplasty in FE models and discuss future opportunities. Femoroplasty has already proven to effectively relieve pain and improve functionality, but there remains uncertainty whether it provides sufficient mechanical strengthening to prevent pathological fractures. FE models could help to select appropriate candidates for whom femoroplasty provides sufficient increase in strength and to further improve the mechanical benefit by optimizing the locations for cement augmentation.
| S-EPMC7292864 | biostudies-literature
Project description:BackgroundTotal ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration.MethodsThis retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits.ResultsOf 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) (P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem.ConclusionOf 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs.Level of evidenceLevel III, retrospective cohort study.
| S-EPMC9619275 | biostudies-literature
Project description:Transcatheter aortic valve replacement (TAVR) first received FDA approval for high-risk surgical patients in 2011 and has been approved for low-risk surgical patients since 2019. It is now the most common type of aortic valve replacement, and its use continues to accelerate. Computer modeling and simulation (CM&S) is a tool to aid in TAVR device design, regulatory approval, and indication in patient-specific care. This study introduces a computational fluid-structure interaction (FSI) model of TAVR with Medtronic's CoreValve Evolut R device using the immersed finite element-difference (IFED) method. We perform dynamic simulations of crimping and deployment of the Evolut R, as well as device behavior across the cardiac cycle in a patient-specific aortic root anatomy reconstructed from computed tomography (CT) image data. These IFED simulations, which incorporate biomechanics models fit to experimental tensile test data, automatically capture the contact within the device and between the self-expanding stent and native anatomy. Further, we apply realistic driving and loading conditions based on clinical measurements of human ventricular and aortic pressures and flow rates to demonstrate that our Evolut R model supports a physiological diastolic pressure load and provides informative clinical performance predictions.
| S-EPMC9832092 | biostudies-literature
Project description:Bone plays an important role in dental implant treatment success. The goal of this literature review is to analyze the influence of bone definition and finite element parameters on stress in dental implants and bone in numerical studies. A search was conducted of Pubmed, Science Direct and LILACS, and two independent reviewers performed the data extraction. The quality of the selected studies was assessed using the Cochrane Handbook tool for clinical trials. Seventeen studies were included. Titanium was the most commonly-used material in dental implants. The magnitude of the applied loads varied from 15 to 300 N with a mean of 182 N. Complete osseointegration was the most common boundary condition. Evidence from this review suggests that bone is commonly defined as an isotropic material, despite being an anisotropic tissue, and that it is analyzed as a ductile material, instead of as a fragile material. In addition, and in view of the data analyzed in this review, it can be concluded that there is no standardization for conducting finite element studies in the field of dentistry. Convergence criteria are only detailed in two of the studies included in this review, although they are a key factor in obtaining accurate results in numerical studies. It is therefore necessary to implement a methodology that indicates which parameters a numerical simulation must include, as well as how the results should be analyzed.
| S-EPMC7464638 | biostudies-literature
Project description:to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications.
| S-EPMC8146716 | biostudies-literature
Project description:BackgroundEnd-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients' experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion.MethodsSeven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically.ResultsThree themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants' valued activities was key to their decision to seek help. Participants' decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a "proper ankle" that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants' individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain.ConclusionsThis study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants' personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.
| S-EPMC9743489 | biostudies-literature
Project description:IntroductionFoot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis.MethodsA three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval.ResultsAt 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites.ConclusionsThe prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.
| S-EPMC4847902 | biostudies-literature
Project description:The Mycoplasma hominis infection is a rare postoperative complication after joint replacement. Based on our knowledge, there were only two cases reported by Korea all over the world currently. A case of postoperative Mycoplasma hominis infection after total knee replacement in our hospital was reported in this article. It was confirmed through mass spectrometer and Mycoplasma cultivation and treated by the first stage debridement, polyethylene insert replacement, and then drainage and irrigation combined with sensitive antibiotics after the operation. We observed that the C reactive protein (CRP) level correlates with the development of disease, while the erythrocyte sedimentation rate (ESR) remains at a high level, indicating the relevance between the Mycoplasma hominis infection caused by knee joint replacement and CRP. This study aims to report the case and review relevant literature.
| S-EPMC5555244 | biostudies-other