Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis.BACKGROUND
 Mobile-bearing ankle implants with good clinical results continued to increase the popularity of total ankle arthroplasty to address endstage ankle osteoarthritis preserving joint movement.  Alternative solutions used fixed-bearing designs, which increase stability and reduce the risk of bearing dislocation, but with a theoretical increase of contact stresses leading to a higher polyethylene wear.  The purpose of this study was to investigate the contact stresses, pressure and area in the polyethylene component of a new total ankle replacement with a fixed-bearing design, using 3D finite element analysis.


 A three-dimensional finite element model of the Zimmer Trabecular Metal Total Ankle was developed and assembled based on computed tomography images.  Three different sizes of the polyethylene insert were modeled, and a finite element analysis was conducted to investigate the contact pressure, the von Mises stresses and the contact area of the polyethylene component during the stance phase of the gait cycle.


 The peak value of pressure was found in the anterior region of the articulating surface, where it reached 19.8 MPa at 40% of the gait cycle.  The average contact pressure during the stance phase was 6.9 MPa.  The maximum von Mises stress of 14.1 MPa was reached at 40% of the gait cycle in the anterior section.  In the central section, the maximum von Mises stress of 10.8 MPa was reached at 37% of the gait cycle, whereas in the posterior section the maximum stress of 5.4 MPa was reached at the end of the stance phase.


 DISCUSSION
 The new fixed-bearing total ankle replacement showed a safe mechanical behavior and many clinical advantages.  However, advanced models to quantitatively estimate the wear are need.


 CONCLUSION
 To the light of the clinical advantages, we conclude that the presented prosthesis is a good alternative to the other products present in the market.
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