1
|
Deschamps K, Mercken K, Verschuren P, Eerdekens M, Vanstraelen E, Wuite S, Matricali GA. Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment. J Foot Ankle Res 2023; 16:85. [PMID: 38017488 PMCID: PMC10683126 DOI: 10.1186/s13047-023-00689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis. METHODS Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model. RESULTS During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001). CONCLUSIONS These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
Collapse
Affiliation(s)
- Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Campus Brugge, Belgium.
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.
| | | | | | - Maarten Eerdekens
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Eline Vanstraelen
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Wuite
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
- Institute for Orthopaedic Research & Training, University Hospitals Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
- Institute for Orthopaedic Research & Training, University Hospitals Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Deleu PA, Naaim A, Chèze L, Dumas R, Devos Bevernage B, Birch I, Besse JL, Leemrijse T. Decreased Mechanical Work Demand in the Chopart Joint After Total Ankle Replacement. Foot Ankle Int 2022; 43:1354-1363. [PMID: 35904211 DOI: 10.1177/10711007221112094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR. METHODS Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work. RESULTS The contribution of the Ankle joint (P = .007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work (P < .001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR (P = .006). CONCLUSION The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group.
Collapse
Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.,Foot & Ankle Institute, Brussels, Belgium
| | - Alexandre Naaim
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Laurence Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Raphaël Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | | | - Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust, Woodhouse Clinic, Sheffield, United Kingdom
| | - Jean-Luc Besse
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, France
| | - Thibaut Leemrijse
- Foot & Ankle Institute, Brussels, Belgium.,CHIREC Delta Hospital, Brussels, Belgium
| |
Collapse
|
3
|
Yang Z, Cui L, Tao S, Zhao J, Wang L, Zhang F, Shao X. Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritis. BMC Surg 2022; 22:178. [PMID: 35568850 PMCID: PMC9107238 DOI: 10.1186/s12893-022-01623-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle distraction arthroplasty and supramalleolar osteotomy were both options for post-traumatic varus ankle arthritis (VAA), but their comparative effectiveness was scarcely reported. This study aimed to compare the outcomes of two operative methods for treatment of Takakura-Tanaka stage 3 post-traumatic VAA. METHODS This was a retrospective study, comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty (n = 32) or supramalleolar osteotomy (n = 41) from January 2016 to December 2019. All patients had a minimum 24-month follow-up assessments. The outcome measures were visual analog scale (VAS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function. RESULTS At an average of 32 months (range, 24-52 months) follow-up, significant improvement was observed for VAS, AOFAS, range of motion (ROM) and most radiographic parameters (except for TAS and TLS for ankle distraction arthroplasty group) compared to preoperative baselines (p < 0.05) for both groups. However, both groups did not differ significantly in terms of VAS or AOFAS, excellent and good rate (78.1% versus 85.4%, p = 0.422), overall rate of postoperative complications (28.1% vs. 17.1%, p = 0.257), or various radiographic parameters (e.g. tibial anterior surface angle, talar tilt angle and tibial lateral surface angle) (all p > 0.05). The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group, in terms of plantarflexion (37.8 ± 4.2 vs. 30.4 ± 3.6, p = 0.006), dorsiflexion (36.5 ± 6.4 vs. 28.3 ± 5.5, p = 0.004), varus (32.1 ± 4.5 vs. 27.1 ± 3.1, p = 0.017) and valgus (28.4 ± 3.7 vs. 25.2 ± 2.8, p = 0.046). CONCLUSIONS Both operative treatments are effective for Takakura-Tanaka stage 3 post-traumatic VAA. In practice, individualized treatment option tailored to the ankle condition and patients' specific need should be considered. LEVEL OF EVIDENCE III, retrospective comparative series.
Collapse
Affiliation(s)
- Zongyu Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China.,Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Liang Cui
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Shiwu Tao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Jianyong Zhao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Li Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Fengqi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Xinzhong Shao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China. .,Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
| |
Collapse
|
4
|
Böpple JC, Tanner M, Campos S, Fischer C, Müller S, Wolf SI, Doll J. Short-term results of gait analysis with the Heidelberg foot measurement method and functional outcome after operative treatment of ankle fractures. J Foot Ankle Res 2022; 15:2. [PMID: 34998420 PMCID: PMC8742407 DOI: 10.1186/s13047-021-00505-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Ankle fractures are common fractures in trauma surgery. Several studies have compared gait patterns between affected patients and control groups. However, no one used the Heidelberg Foot Measurement Method in combination with statistical parametric mapping of the entire gait cycle in this patient cohort. We sought to identify possible mobility deficits in the tibio-talar joint and medial arch in patients after ankle fractures as a sign of stiffness and pain that could result in a pathological gait pattern. We focused on the tibio-talar flexion as it is the main movement in the tibio-talar joint. Moreover, we examined the healing progress over time. Methods Fourteen patients with isolated ankle fractures were included prospectively. A gait analysis using the Heidelberg Foot Measurement Method was performed 9 and 26 weeks after surgery to analyse the tibio-talar dorsal flexion, the foot tibia dorsal flexion, the subtalar inversion and the medial arch as well as the cadence, the walking speed and the ground reaction force. The American Orthopedic Foot & Ankle Society ankle hindfoot score was used to obtain clinical data. Results were compared to those from 20 healthy participants. Furthermore, correlations between the American Orthopedic Foot & Ankle Society hindfoot score and the results of the gait analysis were evaluated. Results Statistical parametric mapping showed significant differences for the Foot Tibia Dorsal Flexion for patients after 9 weeks (53–75%: p = 0.001) and patients after 26 weeks (58–70%: p = 0.011) compared to healthy participants, respectively. Furthermore, significant differences regarding the tibio-talar dorsal flexion for patients 9 weeks after surgery (15–40%: p < 0.001; 56,5–70%: p = 0.007; 82–88%: p = 0.033; 97–98,5%: p = 0.048) as well as patients after 26 weeks (62,5–65%: p = 0.049) compared to healthy participants, respectively. There were no significant differences looking at the medial arch and the subtalar inversion. Moreover, significant differences regarding the ground reaction force were found for patients after 9 weeks (0–17%: p < 0.001; 21–37%: p < 0.001; 41–54%: p < 0.001; 60–64%: p = 0.013) as well as patients after 26 weeks (0–1,5%: p = 0.046; 5–15%: p < 0.001; 27–33%: p = 0.001; 45–49%: p = 0.005; 57–59%: p = 0.049) compared to healthy participants, respectively. In total, the range of motion in the tibio-talar joint and the medial arch was reduced in affected patients compared to healthy participants. Patients showed significant increase of the range of motion between 9 and 26 weeks. Conclusions This study shows, that patients affected by ankle fractures show limited mobility in the tibio-talar joint and the medial arch when compared to healthy participants. Even though the limitation of motion remains at least over a period of 26 weeks, a significant increase can be recognized over time. Furthermore, if we look at the absolute values, the patients’ values tend to get closer to those of the control group. Trial registration This study is registered at the German Clinical Trials Register (DRKS00023379).
Collapse
Affiliation(s)
- Jessica C Böpple
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Michael Tanner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sarah Campos
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian Müller
- ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany
| | - Sebastian I Wolf
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| |
Collapse
|