PMID- 37148636
OWN - NLM
STAT- MEDLINE
DCOM- 20230605
LR  - 20230605
IS  - 1872-7565 (Electronic)
IS  - 0169-2607 (Linking)
VI  - 237
DP  - 2023 Jul
TI  - A combined FE-hybrid MCDM framework for improving the performance of the conical 
      stem tibial design for TAR with the addition of pegs.
PG  - 107574
LID - S0169-2607(23)00239-0 [pii]
LID - 10.1016/j.cmpb.2023.107574 [doi]
AB  - BACKGROUND AND OBJECTIVES: The conical stemmed design of the tibial component for 
      total ankle replacement (TAR) (example Mobility design) uses a single 
      intramedullary stem for primary fixation. Tibial component loosening is a common 
      mode of failure for TAR. Primary causes of loosening are lack of bone ingrowth 
      due to excessive micromotion at the implant-bone interface and bone resorption 
      due to stress shielding after implantation. The fixation feature of the conical 
      stemmed design can be modified with the addition of small pegs to avoid 
      loosening. The aim of the study is to select the improved design for conical 
      stemmed TAR using a combined Finite Element (FE) hybrid Multi-Criteria 
      Decision-Making (MCDM) framework. METHODS: The geometry and material properties 
      of the bone for FE modeling were extracted from the CT data. Thirty-two design 
      alternatives with varying pegs in number (one, two, four, eight), location 
      (anterior, posterior, medial, lateral, anterior-posterior, medial-lateral, 
      equally spaced), and height (5 mm, 4 mm, 3 mm, 2 mm) were prepared. All models 
      were analyzed for dorsiflexion, neutral, and plantarflexion loading. The proximal 
      part of the tibia was fixed. The implant-bone interface coefficient of friction 
      was taken as 0.5. The implant-bone micromotion, stress shielding, volume of bone 
      resection, and surgical simplicity were the important criteria considered for 
      evaluating the performance of TAR. The designs were compared using a hybrid MCDM 
      method of WASPAS, TOPSIS, EDAS, and VIKOR. The weight calculations were based on 
      fuzzy AHP and the final ranks on the Degree of Membership method. RESULTS: The 
      addition of pegs decreased the mean implant-bone micromotions and increased 
      stress shielding. There was a marginal decrease in micromotion and a marginal 
      increase in stress shielding when the peg heights were increased. The results of 
      hybrid MCDM indicated that the most preferable alternative designs were two pegs 
      of 4 mm height in the AP direction to the main stem, two pegs of 4 mm height in 
      the ML direction, and one peg of 3 mm height in the A direction. CONCLUSIONS: 
      Outcomes of this study suggest that the addition of pegs can reduce the 
      implant-bone micromotions. Modified three designs would be useful by considering 
      implant-bone micromotions, stress shielding, volume of bone resection, and 
      surgical simplicity.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Jyoti
AU  - Jyoti
AD  - Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, 
      Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, 
      India.
FAU - Ghosh, Rajesh
AU  - Ghosh R
AD  - Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, 
      Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, 
      India. Electronic address: rajesh@iitmandi.ac.in.
LA  - eng
PT  - Journal Article
DEP - 20230427
PL  - Ireland
TA  - Comput Methods Programs Biomed
JT  - Computer methods and programs in biomedicine
JID - 8506513
SB  - IM
MH  - Tibia/surgery
MH  - *Arthroplasty, Replacement, Ankle
MH  - Prosthesis Design
MH  - *Arthroplasty, Replacement, Knee/methods
MH  - Finite Element Analysis
MH  - Stress, Mechanical
OTO - NOTNLM
OT  - Conical stemmed design
OT  - Finite element analysis
OT  - Hybrid multi-criteria decision making
OT  - Micromotion
OT  - Stress shielding
OT  - Tibial component
OT  - Total ankle replacement
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/05/07 00:42
MHDA- 2023/06/05 06:42
CRDT- 2023/05/06 18:03
PHST- 2022/10/19 00:00 [received]
PHST- 2023/04/10 00:00 [revised]
PHST- 2023/04/26 00:00 [accepted]
PHST- 2023/06/05 06:42 [medline]
PHST- 2023/05/07 00:42 [pubmed]
PHST- 2023/05/06 18:03 [entrez]
AID - S0169-2607(23)00239-0 [pii]
AID - 10.1016/j.cmpb.2023.107574 [doi]
PST - ppublish
SO  - Comput Methods Programs Biomed. 2023 Jul;237:107574. doi: 
      10.1016/j.cmpb.2023.107574. Epub 2023 Apr 27.