Finite element analysis of artificial ankle elastic improved inserts_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Zhi ¹ , LI Yuwan ^2,3 , ZOU Gang ⁴ , JIN Ying ⁴ , RAO Jingcheng ⁵ ,  TIAN Shoujin ⁶

1. Department of Orthopedics, Zhangjiagang Fifth People’s Hospital, Zhangjiagang Jiangsu, 215600, P. R. China;
2. Department of Sports Medicine, Peking University Third Hospital & Institute of Sports Medicine of Peking University, Beijing, 100191, P. R. China;
3. Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P. R. China;
4. Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
5. Department of Orthopedics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian Jiangsu, 223800, P. R. China;
6. Department of Orthopedics, Zhangjiagang Hospital Affiliated to Soochow University, Zhangjiagang Jiangsu, 215600, P. R. China;

Corresponding author：

TIAN Shoujin, Email: tiansurgeon@163.com

Keywords：

Total ankle replacement; artificial ankle; insert; elasticity improvement; finite element analysis

DOI：

10.7507/1002-1892.202307042

Video：

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Objective To discuss the influence of artificial ankle elastic improved inserts (hereinafter referred to as “improved inserts”) in reducing prosthesis micromotion and improving joint surface contact mechanics by finite element analysis. Methods Based on the original insert of INBONE Ⅱ implant system (model A), four kinds of improved inserts were constructed by adding arc or platform type flexible layer with thickness of 1.3 or 2.6 mm, respectively. They were Flying goose type_1.3 elastic improved insert (model B), Flying goose type_2.6 elastic improved insert (model C), Platform type_1.3 elastic improved insert (model D), Platform type_2.6 elastic improved insert (model E). Then, the CT data of right ankle at neutral position of a healthy adult male volunteer was collected, and finite element models of total ankle replacement (TAR) was constructed based on model A-E prostheses by software of Mimics 19.0, Geomagic wrap 2017, Creo 6.0, Hypermesh 14.0, and Abaqus 6.14. Finally, the differences of bone-metal prosthesis interface micromotion and articular surface contact behavior between different models were investigated under ISO gait load. Results The tibia/talus-metal prosthesis interfaces micromotion of the five TAR models gradually increased during the support phase, then gradually fell back after entering the swing phase. The improved models (models B-E) showed lower bone-metal prosthesis interface micromotion when compared with the original model (model A), but there was no significant difference among models A-E (P>0.05). The maximum micromotion of tibia appeared at the dome of the tibial bone groove, and the micromotion area was the largest in model A and the smallest in model E. The maximum micromotion of talus appeared at the posterior surface of the central bone groove, and there was no difference in the micromotion area among models A-E. The contact area of the articular surface of the insert/talus prosthesis in each group increased in the support phase and decreased in the swing phase during the gait cycle. Compared with model A, the articular surface contact area of models B-E increased, but there was no significant difference among models A-E (P>0.05). The change trend of the maximum stress on the articular surface of the inserts/talus prosthesis was similar to that of the contact area. Only the maximum contact stress of the insert joint surface of models D and E was lower than that of model A, while the maximum contact stress of the talar prosthesis joint surface of models B-E was lower than that of model A, but there was no significant difference among models A-E (P>0.05). The high stress area of the lateral articular surface of the improved inserts significantly reduced, and the articular surface stress distribution of the talus prosthesis was more uniform. Conclusion Adding a flexible layer in the insert can improve the elasticity of the overall component, which is beneficial to absorb the impact force of the artificial ankle joint, thereby reducing interface micromotion and improving contact behavior. The mechanical properties of the inserts designed with the platform type and thicker flexible layer are better.

Citation： XU Zhi, LI Yuwan, ZOU Gang, JIN Ying, RAO Jingcheng, TIAN Shoujin. Finite element analysis of artificial ankle elastic improved inserts. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1361-1369. doi: 10.7507/1002-1892.202307042 Copy

1.	Wu Y, Yang H, Guo X, et al. Total ankle replacement with INBONE-Ⅱ prosthesis: A short- to medium-term follow-up study in China. Chin Med J (Engl), 2022, 135(12): 1459-1465.
2.	李亚星, 张晖. 踝关节炎: 保踝手术与踝关节置换术. 中国修复重建外科杂志, 2023, 37(7): 769-775.
3.	Henricson A, Skoog A, Carlsson A. The Swedish ankle arthroplasty register: An analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop, 2007, 78(5): 569-574.
4.	Mondal S, Ghosh R. Experimental and finite element investigation of total ankle replacement: A review of literature and recommendations. J Orthop, 2019, 18: 41-49.
5.	Hermus JP, Voesenek JA, van Gansewinkel EHE, et al. Complications following total ankle arthroplasty: A systematic literature review and meta-analysis. Foot Ankle Surg, 2022, 28(8): 1183-1193.
6.	Mondal S, Ghosh R. Effects of implant orientation and implant material on tibia bone strain, implant-bone micromotion, contact pressure, and wear depth due to total ankle replacement. Proc Inst Mech Eng H, 2019, 233(3): 318-331.
7.	Yu J, Zhao D, Chen WM, et al. Finite element stress analysis of the bearing component and bone resected surfaces for total ankle replacement with different implant material combinations. BMC Musculoskelet Disord, 2022, 23(1): 70.
8.	李银标. UHMWPE人工关节材料增材制造进展. 塑料, 2022, 51(1): 127-130.
9.	Gkiatas I, Karasavvidis T, Sharma AK, et al. Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962, 467 cases. Arch Orthop Trauma Surg, 2022, 142(6): 1177-1184.
10.	Tuncer M, Hansen UN, Amis AA. Prediction of structural failure of tibial bone models under physiological loads: effect of CT density-modulus relationships. Med Eng Phys, 2014, 36(8): 991-997.
11.	Guo X, Zhou J, Tian Y, et al. Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion—a finite element analysis. BMC Musculoskelet Disord, 2021, 22(1): 340.
12.	Zhang Y, Chen Z, Zhao H, et al. Comparison of joint load, motions and contact stress and bone-implant interface micromotion of three implant designs for total ankle arthroplasty. Comput Methods Programs Biomed, 2022, 223: 106976.
13.	Zhang Y, Chen Z, Zhao D, et al. Articular geometry can affect joint kinematics, contact mechanics, and implant-bone micromotion in total ankle arthroplasty. J Orthop Res, 2023, 41(2): 407-417.
14.	Zhang Q, Chen Z, Zhang J, et al. Insert conformity variation affects kinematics and wear performance of total knee replacements. Clin Biomech (Bristol, Avon), 2019, 65: 19-25.
15.	International Organization Environmental Standardization. ISO 22622-2019. Implants for surgery-Wear of total ankle-joint prostheses - Loading and displacement parameters for wear-testing machines with load or displacement control corresponding environmental conditions for test [EB/OL]. (2019-07)[2023-10-12]. https://www.iso.org/standard/73612.html.
16.	徐志, 李豫皖, 金瑛, 等. 步态周期下内侧半月板后根部分撕裂对膝关节生物力学的影响. 中国组织工程研究, 2023, 27(18): 2824-2830.
17.	Martinelli N, Baretta S, Pagano J, et al. Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis. BMC Musculoskelet Disord, 2017, 18(1): 493.
18.	Quevedo González FJ, Steineman BD, Sturnick DR, et al. Biomechanical evaluation of total ankle arthroplasty. Part Ⅱ: Influence of loading and fixation design on tibial bone-implant interaction. J Orthop Res, 2021, 39(1): 103-111.
19.	Messellek AC, Ould Ouali M, Amrouche A. Adaptive finite element simulation of fretting wear and fatigue in a taper junction of modular hip prosthesis. J Mech Behav Biomed Mater, 2020, 111: 103993.
20.	Feyzi M, Fallahnezhad K, Taylor M, et al. A review on the finite element simulation of fretting wear and corrosion in the taper junction of hip replacement implants. Comput Biol Med, 2021, 130: 104196.
21.	Gross CE, Palanca AA, DeOrio JK. Design rationale for total ankle arthroplasty systems: An update. J Am Acad Orthop Surg, 2018, 26(10): 353-359.
22.	McInnes KA, Younger AS, Oxland TR. Initial instability in total ankle replacement: a cadaveric biomechanical investigation of the STAR and agility prostheses. J Bone Joint Surg (Am), 2014, 96(17): e147.

1. Wu Y, Yang H, Guo X, et al. Total ankle replacement with INBONE-Ⅱ prosthesis: A short- to medium-term follow-up study in China. Chin Med J (Engl), 2022, 135(12): 1459-1465.
2. 李亚星, 张晖. 踝关节炎: 保踝手术与踝关节置换术. 中国修复重建外科杂志, 2023, 37(7): 769-775.
3. Henricson A, Skoog A, Carlsson A. The Swedish ankle arthroplasty register: An analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop, 2007, 78(5): 569-574.
4. Mondal S, Ghosh R. Experimental and finite element investigation of total ankle replacement: A review of literature and recommendations. J Orthop, 2019, 18: 41-49.
5. Hermus JP, Voesenek JA, van Gansewinkel EHE, et al. Complications following total ankle arthroplasty: A systematic literature review and meta-analysis. Foot Ankle Surg, 2022, 28(8): 1183-1193.
6. Mondal S, Ghosh R. Effects of implant orientation and implant material on tibia bone strain, implant-bone micromotion, contact pressure, and wear depth due to total ankle replacement. Proc Inst Mech Eng H, 2019, 233(3): 318-331.
7. Yu J, Zhao D, Chen WM, et al. Finite element stress analysis of the bearing component and bone resected surfaces for total ankle replacement with different implant material combinations. BMC Musculoskelet Disord, 2022, 23(1): 70.
8. 李银标. UHMWPE人工关节材料增材制造进展. 塑料, 2022, 51(1): 127-130.
9. Gkiatas I, Karasavvidis T, Sharma AK, et al. Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962, 467 cases. Arch Orthop Trauma Surg, 2022, 142(6): 1177-1184.
10. Tuncer M, Hansen UN, Amis AA. Prediction of structural failure of tibial bone models under physiological loads: effect of CT density-modulus relationships. Med Eng Phys, 2014, 36(8): 991-997.
11. Guo X, Zhou J, Tian Y, et al. Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion—a finite element analysis. BMC Musculoskelet Disord, 2021, 22(1): 340.
12. Zhang Y, Chen Z, Zhao H, et al. Comparison of joint load, motions and contact stress and bone-implant interface micromotion of three implant designs for total ankle arthroplasty. Comput Methods Programs Biomed, 2022, 223: 106976.
13. Zhang Y, Chen Z, Zhao D, et al. Articular geometry can affect joint kinematics, contact mechanics, and implant-bone micromotion in total ankle arthroplasty. J Orthop Res, 2023, 41(2): 407-417.
14. Zhang Q, Chen Z, Zhang J, et al. Insert conformity variation affects kinematics and wear performance of total knee replacements. Clin Biomech (Bristol, Avon), 2019, 65: 19-25.
15. International Organization Environmental Standardization. ISO 22622-2019. Implants for surgery-Wear of total ankle-joint prostheses - Loading and displacement parameters for wear-testing machines with load or displacement control corresponding environmental conditions for test [EB/OL]. (2019-07)[2023-10-12]. https://www.iso.org/standard/73612.html.
16. 徐志, 李豫皖, 金瑛, 等. 步态周期下内侧半月板后根部分撕裂对膝关节生物力学的影响. 中国组织工程研究, 2023, 27(18): 2824-2830.
17. Martinelli N, Baretta S, Pagano J, et al. Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis. BMC Musculoskelet Disord, 2017, 18(1): 493.
18. Quevedo González FJ, Steineman BD, Sturnick DR, et al. Biomechanical evaluation of total ankle arthroplasty. Part Ⅱ: Influence of loading and fixation design on tibial bone-implant interaction. J Orthop Res, 2021, 39(1): 103-111.
19. Messellek AC, Ould Ouali M, Amrouche A. Adaptive finite element simulation of fretting wear and fatigue in a taper junction of modular hip prosthesis. J Mech Behav Biomed Mater, 2020, 111: 103993.
20. Feyzi M, Fallahnezhad K, Taylor M, et al. A review on the finite element simulation of fretting wear and corrosion in the taper junction of hip replacement implants. Comput Biol Med, 2021, 130: 104196.
21. Gross CE, Palanca AA, DeOrio JK. Design rationale for total ankle arthroplasty systems: An update. J Am Acad Orthop Surg, 2018, 26(10): 353-359.
22. McInnes KA, Younger AS, Oxland TR. Initial instability in total ankle replacement: a cadaveric biomechanical investigation of the STAR and agility prostheses. J Bone Joint Surg (Am), 2014, 96(17): e147.

Chinese Journal of Reparative and Reconstructive Surgery

Finite element analysis of artificial ankle elastic improved inserts

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