Malalignment of the total ankle replacement increases peak contact stresses on the bone-implant interface: a finite element analysis

Sanne W.G. van Hoogstraten (Corresponding author), Joris Hermus, Arjan C.Y. Loenen, Jacobus J. Arts, Bert van Rietbergen

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
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Abstract

INTRODUCTION: Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the main reason for the high incidence of TAR failure. As the ankle joint has a small contact area, stresses are typically high, and malalignment may lead to non-homogeneous stress distributions, including stress peaks that may initiate failure. This study aims to elucidate the effect of TAR malalignment on the contact stresses on the bone-implant interface, thereby gaining more understanding of the potential role of malalignment in TAR failure.

METHODS: Finite Element (FE) models of the neutrally aligned as well as malaligned CCI (Ceramic Coated Implant) Evolution TAR implant (Van Straten Medical) were developed. The CCI components were virtually inserted in a generic three-dimensional (3D) reconstruction of the tibia and talus. The tibial and talar TAR components were placed in neutral alignment and in 5° and 10° varus, valgus, anterior and posterior malalignment. Loading conditions of the terminal stance phase of the gait cycle were applied. Peak contact pressure and shear stress at the bone-implant interface were simulated and stress distributions on the bone-implant interface were visualized.

RESULTS: In the neutral position, a peak contact pressure and shear stress of respectively 98.4 MPa and 31.9 MPa were found on the tibial bone-implant interface. For the talar bone-implant interface, this was respectively 68.2 MPa and 39.0 MPa. TAR malalignment increases peak contact pressure and shear stress on the bone-implant interface. The highest peak contact pressure of 177 MPa was found for the 10° valgus malaligned tibial component, and the highest shear stress of 98.5 MPa was found for the 10° posterior malaligned talar model. High contact stresses were mainly located at the edges of the bone-implant interface and the fixation pegs of the talar component.

CONCLUSIONS: The current study demonstrates that TAR malalignment leads to increased peak stresses. High peak stresses could contribute to bone damage and subsequently reduced implant fixation, micromotion, and loosening. Further research is needed to investigate the relationship between increased contact stresses at the bone-implant interface and TAR failure.

Original languageEnglish
Article number463
Number of pages9
JournalBMC Musculoskeletal Disorders
Volume23
Issue number1
DOIs
Publication statusPublished - 17 May 2022

Keywords

  • Ankle Joint/surgery
  • Arthroplasty, Replacement, Ankle/adverse effects
  • Biomechanical Phenomena
  • Bone-Implant Interface
  • Finite Element Analysis
  • Humans
  • Stress, Mechanical
  • Tibia/surgery
  • Total ankle replacement
  • Contact stress
  • Finite element modeling
  • Malalignment
  • Bone-implant interface

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