Abstract
Stapedotomy is performed to restore ossicular chain sound transmission by inserting a piston prosthesis that couples the long process of the incus to the oval window, thereby addressing conductive hearing loss associated with otosclerosis. This study investigates the effects of crimping force, prosthesis material, and loop geometry on incus to optimize fixation while minimizing complications such as incudal necrosis. Finite element analyses were performed to quantify interface pressures and von Mises stresses for titanium prostheses with loop-band widths of 0.2, 0.3, and 0.5 mm under crimping forces of 300-500 mN and for polytetrafluoroethylene (PTFE) prostheses with loop outer diameters (OD) of 1.2, 1.4, and 1.8 mm. The analysis results showed that PTFE prostheses generated significantly lower interface pressures and stress compared to titanium. For PTFE prostheses, the equivalent von Mises stresses remained well below the critical threshold, with values ranging from 3.5 MPa up to peaks of approximately 43 MPa depending on the loop's outer diameter. In contrast, titanium prostheses exhibited a marked dependency on crimping force and band width. At a force of 300 mN, stresses were modest (approximately 16-24 MPa). However, when increasing the force to 400 mN, stresses approached the critical threshold (up to approximately 53 MPa). With crimping forces of 500 mN, especially with band widths greater than 0.3 mm, stresses exceeded the cortical bone strength threshold (approximately 61-64 MPa), indicating an increased risk of mechanical overload and potential incudal necrosis. These findings highlight the importance, in a clinical context, of controlling the crimping force and selecting the material and geometry of the prosthesis to achieve secure coupling while preserving the incus's structural integrity.