1
|
Park GY, Kyung MG, Yoon YS, Kim DY, Lee DO, Lee DY. Change of Segmental Motion Following Total Ankle Arthroplasty Using a 3-Dimensional Multi-segment Foot Model. Clin Orthop Surg 2024; 16:455-460. [PMID: 38827760 PMCID: PMC11130636 DOI: 10.4055/cios23331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 06/04/2024] Open
Abstract
Background Total ankle arthroplasty (TAA) enhances patients' subjective outcomes with respect to pain and function. The aim of this study was to analyze the biomechanical changes of the affected limb following TAA using gait analysis with a 3-dimensional multi-segment foot model (3D MFM). Methods We reviewed medical records, simple radiographs, and gait analyses using a 3D MFM of patients who underwent TAA for severe varus ankle arthritis. Preoperative and postoperative gait data of 24 patients were compared. Postoperative gait analyses were done at least 1 year after surgery. Results TAA significantly increased stride length (p = 0.024). The total range of motion of all planes in the hindfoot and forefoot showed no significant changes between preoperative and postoperative states. Hindfoot was significantly plantarflexed and pronated after TAA, while forefoot was significantly supinated in all phases. After appropriate calculations, the genuine coronal motion of the hindfoot showed no changes after TAA in all phases. Conclusions TAA did not result in biomechanical improvements of segmental motions in the forefoot and hindfoot, except for changes to the bony structures. Therefore, it is important to point out to patients that TAA will not result in significant improvement of ankle function and range of motion. Clinicians can consider this information during preoperative counseling.
Collapse
Affiliation(s)
- Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Yoon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Changes in ankle and foot kinematic after fixed-bearing total ankle replacement. J Biomech 2022; 136:111060. [DOI: 10.1016/j.jbiomech.2022.111060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/14/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
|
3
|
Scott DJ, Kane J, Ford S, Daoud Y, Brodsky JW. Correlation of Patient-Reported Outcomes With Physical Function After Total Ankle Arthroplasty. Foot Ankle Int 2021; 42:646-653. [PMID: 33451259 DOI: 10.1177/1071100720978428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA. METHODS Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval. A Student t test, a multivariate regression, and a Pearson correlation coefficient were used to measure the correlation between parameters of gait and PROMs. RESULTS Patients had statistically significant improvements in gait velocity, total range of motion (ROM), maximum plantarflexion, ankle power, and SF-36 Physical, VAS, and AOFAS scores. The SF-36 Physical score had a moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed and ankle power. No correlation between VAS score and function was detected. The AOFAS score had a moderate positive correlation with postoperative walking speed, step length, and ankle power, and improvement in walking speed, cadence, and ankle power. CONCLUSION Statistically significant correlations were found between numerous preoperative and postoperative comparisons of PROMs and the AOFAS score with the objective biomechanical outcomes of gait. Walking speed and ankle push-off power correlated most with patient perceptions of function and improvement, while pain and ROM did not. Subjective PROMs and objective biomechanical outcomes were complementary in the assessment of surgical outcomes and, combined, helped to address the dilemma of the confounding effect of other lower extremity pathologies on PROMs. LEVEL OF EVIDENCE Level III, comparative series.
Collapse
Affiliation(s)
| | - Justin Kane
- Foot and Ankle Surgery Division, The Orthopedic Institute of North Texas, PA, Frisco, TX, USA.,Orthopaedics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX
| | - Samuel Ford
- Baylor University Medical Center, Dallas, TX, USA
| | - Yahya Daoud
- Baylor University Medical Center, Dallas, TX, USA
| | | |
Collapse
|
4
|
Deleu PA, Naaim A, Leemrijse T, Dumas R, Devos Bevernage B, Besse JL, Crevoisier X, Chèze L. Impact of foot modeling on the quantification of the effect of total ankle replacement: A pilot study. Gait Posture 2021; 84:308-314. [PMID: 33429193 DOI: 10.1016/j.gaitpost.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement. RESEARCH QUESTION The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance. METHODS Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement. RESULTS Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion. SIGNIFICANCE The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.
Collapse
Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France; Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium.
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Thibaut Leemrijse
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Bernhard Devos Bevernage
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Jean-Luc Besse
- Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud, Service De Chirurgie Orthopédique Et Traumatologique, 69495 Pierre-Bénite Cédex, France.
| | - Xavier Crevoisier
- Department of Orthopedics and Traumatology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Laurence Chèze
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| |
Collapse
|
5
|
Change in gait biomechanics after total ankle replacement and ankle arthrodesis: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 73:213-225. [PMID: 32044672 DOI: 10.1016/j.clinbiomech.2020.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/21/2019] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis. METHODS Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status. FINDINGS Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis. INTERPRETATION The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.
Collapse
|
6
|
Marks RM. Mid-Term Prospective Clinical and Radiographic Outcomes of a Modern Fixed-Bearing Total Ankle Arthroplasty. J Foot Ankle Surg 2019; 58:1163-1170. [PMID: 31679668 DOI: 10.1053/j.jfas.2019.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/31/2019] [Accepted: 03/27/2019] [Indexed: 02/03/2023]
Abstract
The early outcomes of the Salto Talaris® Total Ankle Prosthesis have been promising, but information on its mid-term outcomes is still sparse. The purpose of this study was to evaluate the mid-term clinical and radiographic outcomes of this implant among a prospective cohort of patients who underwent total ankle replacement for various etiologies. Forty-six patients (50 ankles) were consecutively enrolled in the study. Our primary aim was to assess implant survivorship as determined by the removal or revision of the implant metal components or conversion to arthrodesis. Our secondary aim was to gauge patient outcomes by using commonly used outcome scores and assess ankle range of motion using goniometric and radiographic methods. We report 100% survivorship of the implant at a mean follow-up of 4.9 years. Compared with preoperative levels, all clinical outcome scores showed significant improvement at the 1-year, 2-year, and 5-year and longer follow-up. The mean clinical ROM improved from 27.7° ± 10.7° preoperatively to 40.0° ± 12.3° at the 2-year follow-up (p < .001). The mean radiographic ROM improved from 23.0° ± 10.2° preoperatively to 27.2° ± 9.1° at the 2-year follow-up (p = .007). Reoperations or secondary procedures were performed on 6 (12%) ankles, with the most common procedure being gutter debridement for impingement symptoms. The study confirms that the excellent survivorship seen with the implant in the early studies extends to mid-term follow-up as well. Patients could expect to see improvement in pain relief and activity well into 5 years after surgery and retain sufficient ankle range of motion for normal gait.
Collapse
Affiliation(s)
- Richard M Marks
- Professor and Chairman, Department of Orthopaedic Surgery, University of South Alabama, Mobile, AL; Professor, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
7
|
McKearney DA, Stender CJ, Cook BK, Moore ES, Gunnell LM, Monier BC, Sangeorzan BJ, Ledoux WR. Altered Range of Motion and Plantar Pressure in Anterior and Posterior Malaligned Total Ankle Arthroplasty: A Cadaveric Gait Study. J Bone Joint Surg Am 2019; 101:e93. [PMID: 31567808 DOI: 10.2106/jbjs.18.00867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malaligned ankle arthroplasty components have been associated with increased postoperative pain and reduced ankle range of motion. With this study, we aimed to quantify how anterior and posterior malalignment of the talar component affects foot bone kinematics and plantar pressures in a dynamic, cadaveric gait simulation. METHODS Ten cadaveric foot specimens received a modified ankle prosthesis. Proper alignment was defined as the prosthesis being neutral to a plantigrade foot, where varus/valgus and internal/external rotation were determined using the tibial alignment guide from the prosthesis manufacturer. Axially loaded lateral radiographs were made to measure the tibiotalar ratio (TTR) preoperatively and postoperatively. Specimens were prepared for gait simulation and mounted into the robotic gait simulator. Foot bone kinematics and plantar pressures were measured for each alignment condition. RESULTS Posterior malalignment of the talar component decreased mean sagittal-plane range of motion (p ≤ 0.0005) in the tibiotalar joint (by up to 3.9°) and in the first metatarsophalangeal joint (by up to 7.7°) and increased sagittal-plane range of motion (p ≤ 0.0005) in the calcaneocuboid joint (by up to 2.0°). Posterior malalignment increased mean transverse-plane range of motion (p ≤ 0.0005 and p = 0.012) in the tibiotalar joint (by up to 2.3°) and in the calcaneocuboid joint (by 2.3°). Posterior malalignment decreased mean peak plantar pressures (p = 0.001 and p = 0.013) under the hallux and the first metatarsal (by up to 82.1 and 110.1 kPa, respectively) and increased (p = 0.012 and p = 0.0006) peak plantar pressures under the third metatarsal and the hindfoot (by 23.0 and 47.8 kPa, respectively). Anterior malalignment decreased (p = 0.0006) mean hindfoot peak plantar pressure (by 127.7 kPa). Anterior and posterior malalignments shifted center of pressure laterally during early and late stance. The TTR weakly to moderately correlated with range-of-motion changes in the tibiotalar, calcaneocuboid, and first metatarsophalangeal joints (r ≤ 0.39) and weakly correlated with plantar pressure changes under the hindfoot, the first metatarsal, and the hallux (r ≤ 0.15). CONCLUSIONS Anterior and posterior malalignments of the talar component altered foot bone kinematics and plantar pressures. Mild malalignments produced fewer significant differences than moderate and extreme malalignments. A greater number of significant differences were found for posterior malalignments than for anterior. The TTR weakly to moderately correlated with changes in range of motion and plantar pressures. CLINICAL RELEVANCE The observed changes in range of motion and plantar pressures may explain why malaligned ankle arthroplasties are associated with unfavorable clinical outcomes and poor prosthesis longevity. Posterior malalignments may produce worse clinical outcomes than anterior malalignments.
Collapse
Affiliation(s)
- Daniel A McKearney
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington.,Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - Christina J Stender
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington
| | - Brian K Cook
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington.,Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - Erik S Moore
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington.,Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - Lea M Gunnell
- Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - Bryan C Monier
- Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - Bruce J Sangeorzan
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington.,Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| | - William R Ledoux
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, Washington.,Departments of Mechanical Engineering (B.K.C. and W.R.L.) and Orthopaedics & Sports Medicine (L.M.G., B.C.M., B.J.S., and W.R.L.), School of Medicine (D.A.M. and E.S.M.), University of Washington, Seattle, Washington
| |
Collapse
|
8
|
Canseco K, Kruger KM, Fritz JM, Konop KA, Tarima S, Marks RM, Harris GF. Distribution of segmental foot kinematics in patients with degenerative joint disease of the ankle. J Orthop Res 2018; 36:1739-1746. [PMID: 29139570 DOI: 10.1002/jor.23807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/11/2017] [Indexed: 02/04/2023]
Abstract
Degenerative joint disease (DJD) of the ankle is a debilitating chronic disease associated with severe pain and dysfunction resulting in antalgic gait alteration. Little information is available about segmental foot and ankle motion distribution during gait in ankle osteoarthritis. The aim of the current study was to dynamically characterize segmental foot and ankle kinematics of patients with severe ankle arthrosis requiring total ankle replacement. This was a prospective study involving 36 (19 M, 17 F) adult patients with a clinical diagnosis of ankle arthrosis ("DJD" group) and 36 (23 M, 13 F) healthy subjects ("Control" group). Motion data were collected at 120 Hz using a 3-D motion camera system at self-selected speed along a 6-m walkway and processed using the Milwaukee Foot Model (MFM). The SF-36 Health Survey and Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were administered to evaluate functional levels. Findings include decreases in walking speed, cadence, stride length and swing phase, and reduced outcomes scores (SF-36 and AOFAS). Multisegemental motion in patients with ankle DJD demonstrates significant changes in foot mechanics characterized by altered segment kinematics and significant reduction in dynamic ROM at the tibia, hindfoot, forefoot, and hallux when compared to controls. The results demonstrate decreased temporal-spatial parameters and low outcomes scores indicative of functional limitations. Statement of clinical significance: Altered segment kinematics and reduced overall range of motion demonstrate how a single joint pathology affects kinematic distribution in the other segments of the foot and ankle and alters patients' overall gait. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1739-1746, 2018.
Collapse
Affiliation(s)
- Karl Canseco
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Suite 323, 1515W. Wisconsin Avenue, Milwaukee, Wisconsin, 53233
| | - Karen M Kruger
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Suite 323, 1515W. Wisconsin Avenue, Milwaukee, Wisconsin, 53233
| | - Jessica M Fritz
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Suite 323, 1515W. Wisconsin Avenue, Milwaukee, Wisconsin, 53233.,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katherine A Konop
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Suite 323, 1515W. Wisconsin Avenue, Milwaukee, Wisconsin, 53233
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard M Marks
- Department of Orthopaedic Surgery, University of South Alabama College of Medicine, Mobile, Alabama
| | - Gerald F Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Suite 323, 1515W. Wisconsin Avenue, Milwaukee, Wisconsin, 53233.,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
9
|
Segal AD, Cyr KM, Stender CJ, Whittaker EC, Hahn ME, Orendurff MS, Ledoux WR, Sangeorzan BJ. A three-year prospective comparative gait study between patients with ankle arthrodesis and arthroplasty. Clin Biomech (Bristol, Avon) 2018; 54:42-53. [PMID: 29550642 DOI: 10.1016/j.clinbiomech.2018.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND End-stage ankle arthritis is a debilitating condition that often requires surgical intervention after failed conservative treatments. Ankle arthrodesis is a common surgical option, especially for younger and highly active patients; however, ankle arthroplasty has become increasingly popular as advancements in implant design improve device longevity. The longitudinal differences in biomechanical outcomes between these surgical treatments remain indistinct, likely due to the challenges associated with objective study of a heterogeneous population. METHODS Patients scheduled for arthroplasty (n = 27) and arthrodesis (n = 20) were recruited to participate in this three-year prospective study. Postoperative functional outcomes were compared at distinct annual time increments using measures of gait analysis, average daily step count and survey score. FINDINGS Both surgical groups presented reduced pain, improved survey scores, and increased walking speed at the first-year postoperative session, which were generally consistent across the three-year follow-up. Arthrodesis patients walked with decreased sagittal ankle RoM, increased sagittal hip RoM, increased step length, and increased transient force at heel strike, postoperatively. Arthroplasty patients increased ankle RoM and cadence, with no changes in hip RoM, step length or heel strike transient force. INTERPRETATION Most postoperative changes were detected at the first-year follow-up session and maintained across the three-year time period. Despite generally favorable outcomes associated with both surgeries, several underlying postoperative biomechanical differences were detected, which may have long-term functional consequences. Furthermore, neither technique was able to completely restore gait biomechanics to the levels of the contralateral unaffected limb, leaving potential for the development of improved surgical and rehabilitative treatments.
Collapse
Affiliation(s)
- Ava D Segal
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA
| | - Krista M Cyr
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA
| | - Christina J Stender
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA
| | - Eric C Whittaker
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA
| | - Michael E Hahn
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Michael S Orendurff
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA
| | - William R Ledoux
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Bruce J Sangeorzan
- Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Queen RM, Franck CT, Schmitt D, Adams SB. Are There Differences in Gait Mechanics in Patients With A Fixed Versus Mobile Bearing Total Ankle Arthroplasty? A Randomized Trial. Clin Orthop Relat Res 2017; 475:2599-2606. [PMID: 28589334 PMCID: PMC5599399 DOI: 10.1007/s11999-017-5405-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is an alternative to arthrodesis, but no randomized trial has examined whether a fixed bearing or mobile bearing implant provides improved gait mechanics. QUESTIONS/PURPOSES We wished to determine if fixed- or mobile-bearing TAA results in a larger improvement in pain scores and gait mechanics from before surgery to 1 year after surgery, and to quantify differences in outcomes using statistical analysis and report the standardized effect sizes for such comparisons. METHODS Patients with end-stage ankle arthritis who were scheduled for TAA between November 2011 and June 2013 (n = 40; 16 men, 24 women; average age, 63 years; age range, 35-81 years) were prospectively recruited for this study from a single foot and ankle orthopaedic clinic. During this period, 185 patients underwent TAA, with 144 being eligible to participate in this study. Patients were eligible to participate if they were able to meet all study inclusion criteria, which were: no previous diagnosis of rheumatoid arthritis, a contralateral TAA, bilateral ankle arthritis, previous revision TAA, an ankle fusion revision, or able to walk without the use of an assistive device, weight less than 250 pounds (114 kg), a sagittal or coronal plane deformity less than 15°, no presence of avascular necrosis of the distal tibia, no current neuropathy, age older than 35 years, no history of a talar neck fracture, or an avascular talus. Of the 144 eligible patients, 40 consented to participate in our randomized trial. These 40 patients were randomly assigned to either the fixed (n = 20) or mobile bearing implant group (n = 20). Walking speed, bilateral peak dorsiflexion angle, peak plantar flexion angle, sagittal plane ankle ROM, peak ankle inversion angle, peak plantar flexion moment, peak plantar flexion power during stance, peak weight acceptance, and propulsive vertical ground reaction force were analyzed during seven self-selected speed level walking trials for 33 participants using an eight-camera motion analysis system and four force plates. Seven patients were not included in the analysis owing to cancelled surgery (one from each group) and five were lost to followup (four with fixed bearing and one with mobile bearing implants). A series of effect-size calculations and two-sample t-tests comparing postoperative and preoperative increases in outcome variables between implant types were used to determine the differences in the magnitude of improvement between the two patient cohorts from before surgery to 1 year after surgery. The sample size in this study enabled us to detect a standardized shift of 1.01 SDs between group means with 80% power and a type I error rate of 5% for all outcome variables in the study. RESULTS This randomized trial did not reveal any differences in outcomes between the two implant types under study at the sample size collected. In addition to these results, effect size analysis suggests that changes in outcome differ between implant types by less than 1 SD. Detection of the largest change score or observed effect (propulsive vertical ground reaction force [Fixed: 0.1 ± 0.1; 0.0-1.0; Mobile: 0.0 ± 0.1; 0.0-0.0; p = 0.0.051]) in this study would require a future trial to enroll 66 patients. However, the smallest change score or observed effect (walking speed [Fixed: 0.2 ± 0.3; 0.1-0.4; Mobile: 0.2 ± 0.3; 0.0-0.3; p = 0.742]) requires a sample size of 2336 to detect a significant difference with 80% power at the observed effect sizes. CONCLUSIONS To our knowledge, this is the first randomized study to report the observed effect size comparing improvements in outcome measures between fixed and mobile bearing implant types. This study was statistically powered to detect large effects and descriptively analyze observed effect sizes. Based on our results there were no statistically or clinically meaningful differences between the fixed and mobile bearing implants when examining gait mechanics and pain 1 year after TAA. LEVEL OF EVIDENCE Level II, therapeutic study.
Collapse
Affiliation(s)
- Robin M Queen
- Kevin P. Granata Biomechanics Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, VA, 24061, USA.
| | | | - Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| |
Collapse
|
11
|
Seo SG, Kim EJ, Lee DJ, Bae KJ, Lee KM, Lee DY. Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults. Foot Ankle Int 2017; 38:1035-1044. [PMID: 28587575 DOI: 10.1177/1071100717709564] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. METHODS Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. RESULTS Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). CONCLUSION Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Sang Gyo Seo
- 1 Department of Orthopedic Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Eo Jin Kim
- 2 Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Doo Jae Lee
- 2 Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kee Jeong Bae
- 3 Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyoung Min Lee
- 4 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Yeon Lee
- 2 Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
12
|
Tenenbaum S, Bariteau J, Coleman S, Brodsky J. Functional and clinical outcomes of total ankle arthroplasty in elderly compared to younger patients. Foot Ankle Surg 2017; 23:102-107. [PMID: 28578792 DOI: 10.1016/j.fas.2016.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is becoming an increasingly utilized procedure for the management of end-stage ankle arthritis. Elderly patients are the fastest growing segment of the population in the western world, creating a unique challenge to the health economics of our era. Determining if elderly patients with end-stage ankle arthritis demonstrate the same improvements in clinical outcomes and functional measures of gait following TAA would be valuable. This can aid to evaluate the utilization of TAA in this enlarging cohort of our population. METHODS Consecutive series of twenty-one patients over the age of 70, who underwent TAA for end-stage ankle arthritis, was prospectively compared to a series of twenty-one patients aged 50-60, who underwent the same procedure by single surgeon during same time period. Clinical outcomes were measured with outcome scores including VAS pain score, AOFAS Ankle and Hindfoot Score, and the SF-36. Three-dimensional gait analysis was performed preoperatively and at a minimum of one year postoperatively, to measure temporal-spatial, kinematic, and kinetic parameters of gait. Mixed model multivariate statistical analysis was used to evaluate and compare the independent contributions to outcomes of the surgical intervention over time; of patient age; and of time-plus-age interaction, as these influenced both the clinical outcomes and the functional gait outcomes. RESULTS Statistically significant improvements in VAS pain scores, AOFAS ankle/hindfoot scores, and SF-36 scores were demonstrated in both age groups. Following surgery, there were improvements in all parameters of gait, including temporal-spatial parameters as step length and walking velocity; kinematic parameters, including, increase in total range of motion to a total of 17-19°; and kinetic parameters, including increase in ankle power and moment. The improvements both in clinical and gait outcomes were equivalent in the two age groups. CONCLUSIONS In this comparative study, it is shown that both elderly patients over the age of 70 and younger patients aged 50-60 demonstrated equivalent improvements clinical and gait outcomes following ankle arthroplasty. This may be important data both for clinical decision-making and the health economics for our ageing population.
Collapse
Affiliation(s)
- Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel HaShomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Jason Bariteau
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott Coleman
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - James Brodsky
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
13
|
Abstract
End-stage ankle arthritis produces severe functional disability, quantifiable by gait abnormalities. In all categories of gait parameters, total ankle arthroplasty (TAA) satistically significantly improves function, compared to patients' preoperative function. There are increases in step length, cadence and velocity; in sagittal plane motion of the ankle, as well has hip and knee motion, and in ankle power and moment. These functional gait improvements correspond to clinical improvements of pain relief and satisfaction. Although these improvements fail to reach the functional performance of healthy controls, the improvement over preoperative function is clinically meaningful and statistically significant.
Collapse
|
14
|
McConnell EP, Queen RM. Correlation of Physical Performance and Patient-Reported Outcomes Following Total Ankle Arthroplasty. Foot Ankle Int 2017; 38:115-123. [PMID: 27698178 DOI: 10.1177/1071100716672656] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Functional recovery following total ankle arthroplasty (TAA) is assessed with patient-reported metrics, but physical performance tests may allow for a more accurate assessment of patient function. We quantified correlations between patient-reported measures and physical performance tests in patients after TAA to determine the usefulness of physical performance tests in post-TAA assessment. METHODS In total, 140 patients with end-stage ankle osteoarthritis were assessed prior to TAA and again at 12 and 24 months postoperatively. At each time point, the visual analog scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS), Short Musculoskeletal Function Assessment (SMFA), and Short-Form 36 (SF-36) scores were collected, as well as walking speed, Four-Square Step Test (FSST) times, and Short Physical Performance Battery (SPPB) balance scores. RESULTS All but 1 (SF-36 general health component) of the patient-reported outcomes improved significantly from preoperative assessment to both 1 and 2 years postoperatively ( P < .001 in all cases). Walking speed, FSST times, and balance scores improved significantly across time ( P < .001 in all cases). Walking speed was moderately correlated with total SF-36 scores at both 1 and 2 years postoperatively ( P < .001 in both cases), both components of the SMFA at 1 year postoperatively ( P < .001 in both cases), and total AOFAS scores at 2 years postoperatively ( P = .001). CONCLUSION The lack of strong correlations between the 2 sets of metrics indicates that they provide different information about a patient's recovery following TAA. Therefore, it is important to include both sets of metrics in post-TAA assessments to better understand operative success and functional recovery. LEVEL OF EVIDENCE Level IV, cohort study.
Collapse
Affiliation(s)
- Evan P McConnell
- 1 Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Robin M Queen
- 2 Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| |
Collapse
|
15
|
Trehan SK, Wolff AL, Gibbons M, Hillstrom HJ, Daluiski A. The effect of simulated elbow contracture on temporal and distance gait parameters. Gait Posture 2015; 41:791-4. [PMID: 25759282 DOI: 10.1016/j.gaitpost.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/09/2015] [Accepted: 02/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters. METHODS Forty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials. RESULTS All three fixed elbow conditions (120°, 90° and 30°) demonstrated significantly decreased gait velocity (1.37, 1.39 and 1.39m/s) and stride length (1.45, 1.46 and 1.46m) compared to the control condition (1.42m/s and 1.48m, respectively). Single limb stance and double support times were decreased and increased, respectively, compared to control. There was no significant difference in cadence or limb asymmetry in the three fixed elbow conditions. CONCLUSIONS Despite well-established functional limitations in elbow contracture patients and importance of arm swing in normal gait, the impact of elbow contractures on gait is unknown. This study demonstrates that simulated elbow contracture results in significant differences in spatio-temporal gait parameters suggesting that elbow contractures have a broader functional impact beyond the affected extremity. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Samir K Trehan
- Department of Hand & Upper Extremity Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Aviva L Wolff
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, 510 East 73rd Street, New York, NY 10021, USA
| | - Mandi Gibbons
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, 510 East 73rd Street, New York, NY 10021, USA
| | - Howard J Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, 510 East 73rd Street, New York, NY 10021, USA
| | - Aaron Daluiski
- Department of Hand & Upper Extremity Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| |
Collapse
|