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Gahr P, Wittmüß J, Martin H, Beyer T, Fischer DC, Mittlmeier T. Placing the tibial component of an ankle prosthesis: results of a CT-based simulation in healthy adults. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04112-4. [PMID: 39331136 DOI: 10.1007/s00590-024-04112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To characterize the 3D geometry of the distal tibia resection area from healthy individuals using CT-based digital implantation for proper preoperative sizing of TAA tibia component placement. METHODS Standardized CT images of healthy ankle joints serving as intra-individual references for treatment of contralateral injuries were identified. The tibial cross section dedicated to virtually host the tibial component was digitally prepared, and the size of the virtual contact surface was calculated. Finally, out of five prototypes the one fitting best in terms of size and alignment was identified. RESULTS CT scans taken from 319 subjects were used for the virtual implantation procedure. Body height and size of the distal tibia contact area correlated (r = 0.49 and 0.42 in females and males, each p < 0.001). Prosthesis sizes 2 and 3 fit well for the vast majority of patients, while the smallest and largest sizes are rarely required. CONCLUSIONS Digital implantation of the tibial component should be considered a valuable tool for preoperative planning as well as for the development of new implant types.
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Affiliation(s)
- Patrick Gahr
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany.
| | - Josephine Wittmüß
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany
| | - Heiner Martin
- Institute for Biomedical Engineering, Rostock, Germany
| | - Thomas Beyer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
| | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany
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2
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Kim J, Bitar R, Gagne O, Palma J, Shaffrey I, Cororaton A, Henry J, Deland J, Ellis S, Demetracopoulos C. Discrepancies Between Intraoperative and Postoperative Ankle Motion Measured for Anterior-Approach Total Ankle Arthroplasty. Foot Ankle Int 2024; 45:426-434. [PMID: 38482821 DOI: 10.1177/10711007241230554] [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] [Indexed: 05/12/2024]
Abstract
BACKGROUND Although intraoperative ankle motion serves as a foundational reference for anticipated motion after surgery and guides the addition of procedures to enhance ankle motion in total ankle arthroplasty (TAA), the relationship between intraoperative and postoperative ankle motion remains unclear. This study aimed to investigate the discrepancy between intraoperative and postoperative ankle range of motion (ROM) following TAAs using the anterior-approach, fixed-bearing systems. METHODS This study retrospectively reviewed 67 patients (67 ankles) who underwent primary TAA at a single institution. Three different types of anterior-approach, fixed-bearing TAA systems were included. Intraoperative fluoroscopy was used to document the maximal dorsiflexion and plantar flexion at the end of the case. Standardized weightbearing maximum dorsiflexion and plantar flexion sagittal radiographs were obtained pre- and postoperatively, following a previously described method. The motion between 3 different time points (preoperative, intraoperative, and postoperative [mean 11.4 months]) was compared using pairwise t tests, and their differences were quantified. RESULTS The mean total tibiotalar ROM was 38.1 degrees (SD 7.8) intraoperatively, and the postoperative total tibiotalar ROM was 24.2 degrees (SD 9.7) (P < .001), indicating that a mean of 65.3% (SD 26.7) of the intraoperative motion was maintained postoperatively. Intraoperative dorsiflexion (mean 11.6 [SD 4.5] degrees) showed no evidence of difference from postoperative dorsiflexion (mean 11.4 [SD 5.8] degrees, P > .99), indicating that a median of 95.6% (interquartile range: 66.2-112) of the intraoperative maximum dorsiflexion was maintained postoperatively. However, there was a significant difference between intraoperative plantarflexion (mean 26.4 [SD 6.3]) and postoperative plantarflexion (12.8 [SD 6.9] degrees, P < .001), indicating a mean 50.6% (SD 29.6) of intraoperative motion maintained in the postoperative assessment. There was an improvement of 2.5 degrees in the total tibiotalar ROM following TAA with statistical significance (P < .043). CONCLUSION This study revealed a significant difference between intraoperative ankle ROM and ankle ROM approximately 1 year after anterior-approach, fixed-bearing TAA, mainly due to plantarflexion motion restriction. Minimal difference in dorsiflexion suggests the importance of achieving the desired postoperative dorsiflexion motion during the surgery using the best possible adjunct procedures. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX, USA
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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3
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Kim J, Demetracopoulos C. Outcomes of Total Ankle Arthroplasty After Reoperation due to Gutter Impingement. Foot Ankle Clin 2024; 29:111-122. [PMID: 38309796 DOI: 10.1016/j.fcl.2023.08.005] [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] [Indexed: 02/05/2024]
Abstract
Gutter impingement is one of the most common causes of subsequent surgery after total ankle arthroplasty (TAA). Although gutter debridement has been reported to resolve preoperative symptoms early on, persistent pain after surgery, recurrence, and poor functional outcome scores have been described in patients who have undergone reoperation for gutter debridement. The cause of gutter impingement after TAA is multifactorial, and a better understanding of its causes and optimal surgical techniques for intervention is needed.
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Affiliation(s)
- Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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4
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Yoon YK, Park KH, Shim DW, Han SH, Lee JW, Jung M. Robotic-assisted foot and ankle surgery: a review of the present status and the future. Biomed Eng Lett 2023; 13:571-577. [PMID: 37872981 PMCID: PMC10590355 DOI: 10.1007/s13534-023-00328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
The surgical application of robotics has increased significantly since its first application in 1985 for a brain biopsy acquisition. Robotic-assisted surgery has been one of the viable options in various surgical areas, and also in orthopaedic surgery. Robotic-assisted orthopaedic surgery has gained popularity as a mean of improving accuracy, reducing complications and achieving better patient satisfaction. Numerous clinical research studies have demonstrated advantages of robotic-assisted orthopaedic surgery, however, most of that researches were about the total knee arthroplasty, total hip arthroplasty and spine surgery. The application of robotic technology in foot and ankle surgery is in a very nascent stage. Furthermore, there has been little research on intraoperative use of robotics in foot and ankle surgery in literature. A review of previous preclinical studies in foot and ankle robotics and clinical research studies in various fields of robot-assisted orthopaedic surgery shows that its potential application and benefits over conventional techniques, such as total ankle arthroplasty, minimally invasive surgery for foot and ankle trauma or other corrective procedure, and intraoperative biomechanical testing. More studies on practical application of robotic technology to surgical procedure in the field of foot and ankle surgery are needed to confirm its clinical usefulness and cost effectiveness.
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Affiliation(s)
- Yeo Kwon Yoon
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Woo Shim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Jung
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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5
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Ledoux WR. Role of Robotic Gait Simulators in Elucidating Foot and Ankle Pathomechanics. Foot Ankle Clin 2023; 28:45-62. [PMID: 36822688 DOI: 10.1016/j.fcl.2022.11.005] [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: 01/03/2023]
Abstract
Testing with cadaveric foot and ankle specimens began as mechanical techniques to study foot function and then evolved into static simulations of specific instances of gait, before technologies were eventually developed to fully replicate the gait cycle. This article summarizes the clinical applications of dynamic cadaveric gait simulation, including foot bone kinematics and joint function, muscle function, ligament function, orthopaedic foot and ankle pathologies, and total ankle replacements. The literature was reviewed and an in-depth summary was written in each section to highlight one of the more sophisticated simulators. The limitations of dynamic cadaveric simulation were also reviewed.
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Affiliation(s)
- William R Ledoux
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
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6
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Henry JK, Sturnick D, Rosenbaum A, Saito GH, Deland J, Steineman B, Demetracopoulos C. Cadaveric Gait Simulation of the Effect of Subtalar Arthrodesis on Total Ankle Replacement Kinematics. Foot Ankle Int 2022; 43:1110-1117. [PMID: 35466728 DOI: 10.1177/10711007221088821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients undergoing total ankle replacement (TAR) often have symptomatic adjacent joint arthritis and deformity. Subtalar arthrodesis can effectively address a degenerative and/or malaligned hindfoot, but there is concern that it places abnormal stresses on the TAR and adjacent joints of the foot, potentially leading to early TAR failure. This study hypothesized that ankle and talonavicular joint kinematics would be altered after subtalar arthrodesis in the setting of TAR. METHODS Thirteen mid-tibia cadaveric specimens with neutral alignment were tested in a robotic gait simulator. To simulate gait, each specimen was secured to a static mounting fixture about a 6-degree of freedom robotic platform, and a force plate moves relative to the stationary specimen based on standardized gait parameters. Specimens were tested sequentially in TAR and TAR with subtalar arthrodesis (TAR-STfuse). Kinematics and range of motion of the ankle and talonavicular joint were compared between TAR and TAR-STfuse. RESULTS There were significant differences in kinematics and range of motion between TAR and TAR-STfuse groups. At the ankle joint, TAR-STfuse had less internal rotation in early-mid stance (P < .05), with decreased range of motion in the sagittal (-2.7 degrees, P = .008) and axial (-1.8 degrees, P = .002) planes in early stance, and increased range of motion in the coronal plane in middle (+1.2 degrees, P < .001) and late (+2.5 degrees, P = .012) stance. At the talonavicular joint, there were significant differences in axial and coronal kinematics in early and late stance (P < .05). Subtalar arthrodesis resulted in significantly decreased talonavicular range of motion in all planes in early and late stance (P < .003). CONCLUSION In ankles implanted with the TAR design used in this study, kinematics of the ankle and talonavicular joint were found to be altered after subtalar arthrodesis. Aberrant motion may reflect altered contact mechanics at the prosthesis and increased stress at the bone-implant interface, and affect the progression of adjacent joint arthritis in the talonavicular joint. CLINICAL RELEVANCE These findings may provide a correlate to clinical studies that have cited hindfoot arthrodesis as a risk factor for TAR failure.
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Affiliation(s)
- Jensen K Henry
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Andrew Rosenbaum
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA.,The Bone & Joint Center, Albany, NY, USA
| | - Guilherme Honda Saito
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Johnathan Deland
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Brett Steineman
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
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7
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Wu SX, Liu SZ, Ling M, Che YH, Tian X, Duan XL, Yi Z. A Novel Method for Preoperative Positioning of Total Ankle Replacement Using 3D Digital Model. Orthop Surg 2022; 14:1378-1384. [PMID: 35656705 PMCID: PMC9251280 DOI: 10.1111/os.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses. METHODS Computed tomography images of intact ankle joints from 54 cases in the outpatient and inpatient departments of our hospital were collected; according to the INBONE® total ankle system surgery process, the surgery model and surgical osteotomy were finished using MIMICS based on computer simulation method. The shortest distance was measured between the center point and the anterior, posterior, medial, and lateral, respectively, to ensure the precise position of the ankle replacement prosthesis by digital simulation surgery. The relationship between the two variables was analyzed by bivariate correlation analysis. RESULTS The dataset of this study included 48 cases of the sub-data set (26 males and 22 females) and included 27 cases of left ankle and 21 cases of right ankle. The average medial malleolar angle was 18.67°± 2.87°, the average amount of bone resection was 12.13 ± 1.86 cm3 , the mid-anterior distance was 1.72 ± 0.19 cm, the mid-posterior distance was 2.00 ± 0.19 cm, the ratio of mid-anterior to mid-posterior was 0.87, the mid-medial distance was 1.26 ± 0.17 cm, the mid-lateral distance was 1.19 ± 0.16 cm, and the ratio of mid-medial to mid-lateral was 1.06. After osteotomy, the anteroposterior diameter was 3.73 ± 0.32 cm, the transverse diameter was 2.46 ± 0.27 cm, and the ratio of anteroposterior diameter to transverse diameter was 1.53. In the bottom view, the shape after osteotomy is rectangular. The mid-anterior distance was strongly negatively correlated with age, the mid-anterior distance and the amount of bone resection, the mid-medial distance and the amount of bone resection, the mid-lateral distance and the amount of bone resection, the mid-lateral distance and the anteroposterior diameter, the anteroposterior diameter and the transverse diameter were all strongly positively correlated. CONCLUSION The projection point of the lower tibia centerline on the tibial horizontal osteotomy surface is located at a position slightly anterior to the midpoint of the transverse diameter after ankle arthroplasty. The rational positioning of the total ankle replacement is located at both a position slightly anterior to the midpoint of the transverse diameter and midpoint of the anteroposterior diameter, which can be used as a reference method before total ankle arthroplasty surgery.
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Affiliation(s)
- Shi-Xun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China.,The College of Life Sciences and Medicine, Northwest University, xi'an, China
| | - Shi-Zhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan-Hui Che
- First Middle School of Xi'an City, Xi'an, China
| | - Xin Tian
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiang-Long Duan
- The College of Life Sciences and Medicine, Northwest University, xi'an, China.,Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhi Yi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
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8
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Koivu H, Kormi S, Kohonen I, Tiusanen H. The motion between components in a mobile-bearing total ankle replacement measured by cone-beam CT scanning. Foot Ankle Surg 2022; 28:324-330. [PMID: 33858758 DOI: 10.1016/j.fas.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND To measure the motion of polyethylene insert and implant components of mobile-bearing total ankle replacement (TAR) by cone-beam CT scanning. METHODS 10 TAR patients with high amount of clinical motion after the CCI implant (Ceramic Coated Implant; Wright Medical Technology, Arlington, TN, USA) with average age at operation 64,3 years (range 47-84) and average clinical total range of motion 42 degrees (range 35-55) were included. RESULTS The average total range of motion between the insert and the tibial component was 0.8mm (range 0-2) in the coronal plane, and 2.9mm (range 1-6) in the sagittal plane. There was wide variation in the axial rotation measurements between the components. CONCLUSION We found measurable motion between the mobile-bearing insert and the tibial component in all planes. The relevance of this motion to the function and long-term survival of the TAR remains to be determined.
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Affiliation(s)
- Helka Koivu
- Pohjola Sairaala, Joukahaisenkatu 9, Turku 20520, Finland.
| | - Sami Kormi
- Turku University Hospital, Luolavuorentie 2, Turku 20700, Finland.
| | - Ia Kohonen
- Turku University Hospital, Hämeentie 11, Turku 20520, Finland.
| | - Hannu Tiusanen
- Turku University Hospital, Luolavuorentie 2, Turku 20700, Finland.
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9
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Fritz JM, Canseco K, Konop KA, Kruger KM, Tarima S, Long JT, Law BC, Kraus JC, King DM, Harris GF. Multi-segment foot kinematics during gait following ankle arthroplasty. J Orthop Res 2022; 40:685-694. [PMID: 33913547 DOI: 10.1002/jor.25062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/13/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Ankle arthritis is a debilitating disease marked by pain and limited function. Total ankle arthroplasty improves pain while preserving motion and offers an alternative to the traditional treatment of ankle fusion. Gait analysis and functional outcomes tools can provide an objective balanced analysis of ankle replacement for the treatment of ankle arthritis. Twenty-nine patients with end-stage ankle arthritis were evaluated before and after ankle arthroplasty. Multi-segment foot and ankle kinematics were assessed annually following surgery (average 3.5 years, range 1-6 years) using the Milwaukee Foot Model and a Vicon video motion analysis system. Functional outcomes (American Orthopedic Foot and Ankle Society [AOFAS] ankle/hindfoot scale, short form 36 [SF-36] questionnaire) and temporal-spatial parameters were also assessed. Kinematic results were compared to findings from a previously collected group of healthy ambulators. AOFAS and SF-36 mean scores improved postoperatively. Walking speed and stride length increased after surgery. There were significant improvements in tibial sagittal range of motion in terminal stance and hindfoot sagittal range of motion in preswing. Decreased external rotation of the tibia and increased external rotation of the hindfoot were noted throughout the gait cycle. Pain and function improved after ankle replacement as supported by better outcomes scores, increased temporal-spatial parameters, and significant improvement in tibial sagittal range of motion during terminal stance and hindfoot sagittal range of motion during preswing. While multi-segment foot kinematics were improved, they were not restored to control values. Statement of clinical significance: Total ankle arthroplasty does not fully normalize mutli-segment gait kinematics despite improved patient-reported outcomes and gait mechanics.
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Affiliation(s)
- Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karl Canseco
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine A Konop
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen M Kruger
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
| | - Sergey Tarima
- Department of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason T Long
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian C Law
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan C Kraus
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gerald F Harris
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
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10
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Zeitlin J, Henry J, Ellis S. Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery. HSS J 2021; 17:326-332. [PMID: 34539274 PMCID: PMC8436345 DOI: 10.1177/15563316211026325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.
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Affiliation(s)
| | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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11
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Leardini A, Stebbins J, Hillstrom H, Caravaggi P, Deschamps K, Arndt A. ISB recommendations for skin-marker-based multi-segment foot kinematics. J Biomech 2021; 125:110581. [PMID: 34217032 DOI: 10.1016/j.jbiomech.2021.110581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both kinematic and kinetic analyses. These models differ in the number of segments analyzed, bony landmarks identified, required marker set, defined anatomical axes and frames, the convention used to calculate joint rotations and the determination of neutral positions or other offsets from neutral. Many of these models lack validation. The terminology used is inconsistent and frequently confusing. Biomechanical and clinical studies using these models should use established references and describe how results are obtained and reported. The International Society of Biomechanics has previously published proposals for standards regarding kinematic and kinetic measurements in biomechanical research, and in this paper also addresses multi-segment foot kinematics modeling. The scope of this work is not to prescribe a particular set of standard definitions to be used in all applications, but rather to recommend a set of standards for collecting, calculating and reporting relevant data. The present paper includes recommendations for the overall modeling and grouping of the foot bones, for defining landmarks and other anatomical references, for addressing the many experimental issues in motion data collection, for analysing and reporting relevant results and finally for designing clinical and biomechanical studies in large populations by selecting the most suitable protocol for the specific application. These recommendations should also be applied when writing manuscripts and abstracts.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, NY, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kevin Deschamps
- Faculty of Movement & Rehabilitation Sciences, KULeuven, Bruges, Belgium
| | - Anton Arndt
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden
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12
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Rushing CJ, Zulauf E, Hyer CF, Berlet GC. Risk Factors for Early Failure of Fourth Generation Total Ankle Arthroplasty Prostheses. J Foot Ankle Surg 2021; 60:312-317. [PMID: 33168439 DOI: 10.1053/j.jfas.2020.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
A number of 2-component, fourth generation total ankle arthroplasty (TAA) prostheses have been introduced to the market in the past few years, as the popularity and indications for TAA have continued to expand. The purpose of the present study was to identify independent risk factors for the early failure of fourth generation TAA prostheses. A total of 97 ankles underwent TAA with a fourth generation prostheses (INFINITY, CADENCE) between August 2015 and June 2018 at a single institution and were at least 6 months postoperative (mean 18.3 months, range 6-43). The primary outcome assessed was the need for revision surgery, defined as removal of 1 or both metal components for any reason, excluding infection. Baseline patient demographics, characteristics, radiographic alignment parameters, and distal tibia cortical bone thickness (CBT) were assessed. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed. Three ankles (3.1%) underwent revision surgery for aseptic loosening at a mean of 24.3 (range, 16-31) months; all had a CBT <4 mm. Independent predictors for reoperation were CBT <4 mm, presence of diabetes, and ipsilateral hindfoot fusion (p = .04). No associations were identified for purported risk factors (age, body mass index, and coronal deformity). The present study is the first to suggest a potential relationship between reduced CBT of the distal tibia, and TAA failure. Additional studies are warranted to better understand the role of bone density in TAA survivorship.
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Affiliation(s)
- Calvin J Rushing
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH.
| | - Emily Zulauf
- Foot and Ankle Surgeon, Grant Medical Center, Columbus, OH
| | - Christopher F Hyer
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Gregory C Berlet
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
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Flury A, Viehöfer AF, Hoch A, Vlachopoulos L, Wirth SH, Imhoff FB. Talar neck angle correlates with tibial torsion-Guidance for 3D and 2D measurements in total ankle replacement. J Orthop Res 2021; 39:788-796. [PMID: 33247851 DOI: 10.1002/jor.24928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/12/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Axial plane alignment of the talar component in total ankle arthroplasty is poorly understood and remains a major issue, especially since malpositioning results in increased peak pressure and rotational torque. Further profound knowledge regarding individual anatomy of the talus and its relation to proximal and distal osseous structures is therefore needed. Therefore, three-dimensional (3D) surface models of 50 lower extremities were generated using computed tomography data of patients without ankle osteoarthritis. The talus neck torsion was measured using a novel 3D measurement method. Then, tibial torsion and subtalar joint axis orientation were measured and correlated to the talus neck torsion. Moreover, a 2D measurement method of the talus neck torsion was developed. A statistically significant correlation was found between external tibia torsion and medial talus neck torsion, as well as talus neck axis and subtalar joint axis in the transversal and frontal plane. The novel defined 3D measurement methods indicated excellent inter-rater and intra-rater reliability. The 2D measurement method of the talus neck torsion was in good agreement with the 3D method. The results showed that the rotational profiles of the tibia, talus, and adjacent joints are interconnected, which should be considered in total ankle replacement (TAR). Clinical relevance: This study improves the overall understanding of the talar anatomy, as well as its relationship to adjacent osseous structures. The novel 2D measurement method of the talus neck torsion might improve talar component positioning in the axial plane corresponding to the patient's individual anatomy, and therefore improve the survival rate of TAR.
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Affiliation(s)
- Andreas Flury
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Arnd F Viehöfer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armando Hoch
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian B Imhoff
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Hintermann B, Susdorf R, Krähenbühl N, Ruiz R. Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty. Foot Ankle Int 2020; 41:521-528. [PMID: 31996033 DOI: 10.1177/1071100720902838] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The presence of an interface between the tibial component and the polyethylene insert (PI) in mobile-bearing total ankle arthroplasty (TAA) may allow the talus to adapt its axial position according to the patient's anatomy. However, little is known about differences of the axial talar rotation between patients following mobile-bearing TAA. Therefore, the aim of this study was to assess the relative axial rotation between the talar and tibial component intraoperatively and after a minimum follow-up of 3 years following mobile-bearing TAA. METHODS The relative axial rotation between the talar and the tibial component was measured intraoperatively in a cohort of 58 patients who underwent mobile-bearing TAA. In addition, it was measured on weightbearing computed tomography (CT) scans in 48 patients after a mean of 6.3 (3.0-16.3) years following mobile-bearing TAA. The pre- and postoperative alignment of the ankle joint/tibial component and hindfoot assessed on conventional radiographs was correlated with the intra- and postoperatively determined relative axial rotation of the talar and tibial component. RESULTS The mean intra- and postoperative axial talar component position was 1.7 (range, 14 internal to 14 external) and 1.4 (range, 12 internal to 20 external) degrees toward internal when compared to the tibial component (P = .960). The preoperative sagittal alignment of the distal tibia correlated with the intraoperatively determined relative axial rotation between the talar and the tibial component (P = .019). CONCLUSION The wide range of the relative axial rotation between the tibial and talar component suggests that it is crucial to allow the talus to intraoperatively find a position that corresponds to the patient's individual anatomy. The fact that the range of axial rotation was similar after a minimum of 3 years measured under weightbearing conditions suggests that structural changes of the osteoarthritic ankle may be the main determining factors for the axial rotational position of the talus. Our findings improve current understanding of proper implant position during TAA. In addition, the current study provides a reliable method to assess the postoperative axial position of the prosthesis components. The high interindividual variability of the relative rotation between the tibial and talar component in the axial plane suggests that axial malpositioning following TAA may be a more common issue than currently expected. Our findings may help to improve the assessment of patients with persistent pain following TAA. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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