Misalignment of Total Ankle Components Can Induce High Joint Contact Pressures

被引:128
作者
Espinosa, N. [1 ]
Walti, M. [1 ]
Favre, P. [1 ]
Snedeker, J. G. [1 ]
机构
[1] Univ Zurich, Dept Orthoped, Balgrist Hosp, CH-8008 Zurich, Switzerland
关键词
AGILITY TOTAL ANKLE; FINITE-ELEMENT-ANALYSIS; FOLLOW-UP; REPLACEMENT; ARTHROPLASTY; BEARING; DESIGN; CEMENTLESS; SIMULATION; WEAR;
D O I
10.2106/JBJS.I.00287
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: A major cause of the limited longevity of total ankle replacements is premature polyethylene component wear, which can be induced by high joint contact pressures. We implemented a computational model to parametrically explore the hypothesis that intercomponent positioning deviating from the manufacturer's recommendations can result in pressure distributions that may predispose to wear of the polyethylene insert. We also investigated the hypothesis that a modern mobile-bearing design may be able to better compensate for imposed misalignments compared with an early two-component design. Methods: Two finite element models of total ankle replacement prostheses were built to quantify peak and average contact pressures on the polyethylene insert surfaces. Models were validated by biomechanical testing of the two implant designs with use of pressure-sensitive film. The validated models were configured to replicate three potential misalignments with the most clinical relevance: version of the tibial component, version of the talar component, and relative component rotation of the two-component design. The misalignments were simulated with use of the computer model with physiologically relevant boundary loads. Results: With use of the manufacturer's guidelines for positioning of the two-component design, the predicted average joint contact pressures exceeded the yield stress of polyethylene (18 to 20 MPa). Pressure magnitudes increased as implant alignment was systematically deviated from this reference position. The three-component design showed lower-magnitude contact pressures in the standard position (<10 MPa) and was generally less sensitive to misalignment. Both implant systems were sensitive to version misalignment. Conclusions: In the tested implants, a highly congruent mobile-bearing total ankle replacement design yields more evenly distributed and lower-magnitude joint contact pressures than a less congruent design. Although the mobile-bearing implant reduced susceptibility to aberrant joint contact characteristics that were induced by misalignment, predicted average contact stresses reached the yield stress of polyethylene for imposed version misalignments of >5 degrees.
引用
收藏
页码:1179 / 1187
页数:9
相关论文
共 26 条
[1]   Uncemented STAR total ankle prostheses -: Three to eight-year follow-up of fifty-one consecutive ankles [J].
Anderson, T ;
Montgomery, F ;
Carlsson, Å .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2003, 85A (07) :1321-1329
[2]   TOTAL ANKLE ARTHROPLASTY - A LONG-TERM REVIEW OF THE LONDON HOSPITAL EXPERIENCE [J].
BOLTONMAGGS, BG ;
SUDLOW, RA ;
FREEMAN, MAR .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1985, 67 (05) :785-790
[3]   Twenty-year evaluation of cementless, mobile-bearing total ankle replacements [J].
Buechel, FF ;
Buechel, FF ;
Pappas, MJ .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2004, (424) :19-26
[4]   Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total ankle replacement [J].
Buechel, FF ;
Buechel, FF ;
Pappas, MJ .
FOOT & ANKLE INTERNATIONAL, 2003, 24 (06) :462-472
[5]  
Cracchiolo A, 2008, J AM ACAD ORTHOP SUR, V16, P530
[6]   Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis [J].
Godest, AC ;
Beaugonin, M ;
Haug, E ;
Taylor, M ;
Gregson, PJ .
JOURNAL OF BIOMECHANICS, 2002, 35 (02) :267-275
[7]  
Hoffmann AH, 2007, ORTHOPADE, V36, P908, DOI 10.1007/s00132-007-1141-0
[8]   Radiographic and biomechanical support for fibular plating of the agility total ankle [J].
Jung, HG ;
Nicholson, JJ ;
Parks, B ;
Myerson, MS .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2004, (424) :118-124
[9]   The agility total ankle arthroplasty - Seven to sixteen-year follow-up [J].
Knecht, SI ;
Estin, M ;
Callaghan, JJ ;
Zimmerman, MB ;
Alliman, KJ ;
Alvine, FG ;
Saltzman, CL .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2004, 86A (06) :1161-1171
[10]   Ankle arthroplasties generate wear particles similiar to knee arthroplasties [J].
Kobayashi, A ;
Minoda, Y ;
Kadoya, Y ;
Ohashi, H ;
Takaoka, K ;
Saltzman, CL .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2004, (424) :69-72