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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.
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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
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Barylak M, Arena S, Hamlin S, Queen R. End-stage ankle arthritis alters dynamic stability during gait as measured by margin of stability between limbs and compared to healthy controls. Gait Posture 2024; 113:13-17. [PMID: 38820764 DOI: 10.1016/j.gaitpost.2024.05.021] [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] [Received: 11/02/2023] [Revised: 02/20/2024] [Accepted: 05/18/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE This study aimed to assess dynamic stability in individuals with end-stage ankle arthritis compared to healthy controls by evaluating the margin of stability (MoS) during gait. DESIGN A cohort of 50 participants with end-stage ankle arthritis (AA) and 50 matched healthy controls (HC) were analyzed from an IRB approved database. Kinematic data were collected using an eight-camera motion analysis system, and MoS was calculated based on the extrapolated center of mass (XCoM) and the base of support (BoS). Statistical analysis was performed using a linear mixed effects model with gait speed as a covariate. RESULTS The analysis revealed a significant interaction between the group (AA vs. HC) and limb (arthritic vs. non-arthritic) at heel-strike and midstance. The non-arthritic limb demonstrated a significantly smaller AP MoS during heel-strike compared to the arthritic limb and either of the limbs of the HC group (p < 0.001). The arthritic limb demonstrated a significantly greater ML MoS during midstance compared to the non-arthritic limb and either of the limbs of the HC group (p < 0.001). AA group had significant slower gait speed (p < 0.001), smaller step length (p = 0.015) and smaller locomotor rehabilitation index (p < 0.001) than HC. CONCLUSION Individuals with end-stage ankle arthritis exhibit altered dynamic stability during gait, with a significantly smaller AP MoS on the non-arthritic limb at heel-strike and greater ML MoS on the arthritic limb at midstance compared to healthy controls. Our results suggest that individuals with ankle arthritis are less stable when navigating single limb support of the arthritic limb. Further research should further examine the associations with fall risk in patients with ankle arthritis and evaluate the effectiveness of therapeutic interventions targeting these factors.
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Affiliation(s)
- Martin Barylak
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Sara Arena
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Stephanie Hamlin
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States; Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.
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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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Schmitt D, Sparling TL, Queen RM. The effect of total ankle arthroplasty on mechanical energy exchange. J Biomech 2024; 164:111941. [PMID: 38325194 DOI: 10.1016/j.jbiomech.2024.111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
Total ankle arthroplasty (TAA) is a common surgical solution for patients with debilitating arthritis of the ankle. Prior to surgery patients experience high levels of pain and fatigue and low mechanical energy recovery. It is not known if TAA restores healthy levels of mechanical energy recovery in this patient population. This study was designed to determine whether mechanical energy recovery was restored following TAA. Ground reaction forces during self-selected speed walking were collected from patients with symptomatic, unilateral ankle arthritis (N = 29) before and one and two years after primary, unilateral TAA. The exchange of potential (PE) and kinetic (KE) energy was examined, and direction of change (%congruity) and energy exchange (%recovery) between the two curves was calculated, with those subjects with low congruity experiencing high energy recovery. Linear regressions were used to examine the impact of walking speed, congruity, and amplitude of the center of mass (COM) displacement on %recovery, while ANOVA and ANCOVA models were used to compare energy recovery and congruity across the three time points. Gender, BMI, and age at surgery had no effect in this study. TAA improved walking speed (p = 0.001), increased energy recovery (p = 0.020), and decreased congruity (p = 0.002), and these levels were maintained over at least two years. Differences in congruity were independent of walking speed. In some patients, especially those who are severely debilitated by ankle arthritis, TAA is effective in restoring mechanical energy recovery to levels similar to an asymptomatic population of a similar age recorded by other studies.
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Affiliation(s)
- Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham NC, USA.
| | - Tawnee L Sparling
- Department of Evolutionary Anthropology, Duke University, Durham NC, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA.
| | - Robin M Queen
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Blacksburg, VA, USA; Virginia Tech Carilion School of Medicine, Department of Orthopaedic Surgery, Roanoke, VA, USA.
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Stark NEP, Streamer J, Queen R. Patients with unilateral ankle arthritis have decreased discrete and time-series limb symmetry compared to healthy controls. J Orthop Res 2023; 41:1953-1964. [PMID: 36866826 PMCID: PMC10440243 DOI: 10.1002/jor.25541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Patients with ankle arthritis (AA) have side-to-side limb differences at the ankle and in spatiotemporal measures; however, the degree of symmetry between limbs has not been compared to a healthy population. The purpose of this study was to determine differences in limb symmetry during walking for discrete and time-series measures when comparing patients with unilateral AA to healthy participants. Thirty-seven AA and 37 healthy participants were age, gender, and body mass index matched. Three-dimensional gait mechanics and ground reaction force (GRF) were captured during four to seven walking trails. GRF and hip and ankle mechanics were extracted bilaterally for each trial. The Normalized Symmetry Index and Statistical Parameter Mapping were used to assess discrete and time-series symmetry, respectively. Discrete symmetry was analyzed using linear mixed-effect models to determine significant differences between groups (α = 0.05). Compared to healthy participants, patients with AA had decreased weight acceptance (p = 0.017) and propulsive (p < 0.001) GRF, ankle plantarflexion (p = 0.021), ankle dorsiflexion (p = 0.010), and ankle plantarflexion moment (p < 0.001) symmetry. Significant regions of difference were found between limbs and groups throughout the stance phase for the vertical GRF force (p < 0.001), the ankle angle during push-off (p = 0.047), the plantarflexion moment (p < 0.001), and the hip extension angle (p = 0.034) and moment (p = 0.010). Patients with AA have decreased symmetry in the vertical GRF and at the ankle and hip during the weight acceptance and propulsive portions of the stance phase. Therefore, clinicians should try a non improving symmetry focusing on changing hip and ankle mechanics during the weight acceptance and propulsive phases of gait.
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Affiliation(s)
- Nicole E-P. Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Jill Streamer
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
- Department of Orthopaedic Surgery, Virginia Tech – Carilion School of Medicine, Roanoke, VA, USA
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Fritz J, Rashidi A, de Cesar Netto C. Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction. Foot Ankle Clin 2023; 28:463-492. [PMID: 37536814 DOI: 10.1016/j.fcl.2023.05.012] [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: 08/05/2023]
Abstract
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
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Affiliation(s)
- Jan Fritz
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Duke University, Durham, NC, USA.
| | - Ali Rashidi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY 10016, USA
| | - Cesar de Cesar Netto
- Department of Radiology, Molecular Imaging Program at StanDepartment of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
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Sancho-Bru JL, Sanchis-Sales E, Rodríguez-Cervantes PJ, Vergés-Salas C. Foot Sole Contact Forces vs. Ground Contact Forces to Obtain Foot Joint Moments for In-Shoe Gait-A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6744. [PMID: 37571530 PMCID: PMC10422389 DOI: 10.3390/s23156744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
In-shoe models are required to extend the clinical application of current multisegment kinetic models of the bare foot to study the effect of foot orthoses. Work to date has only addressed marker placement for reliable kinematic analyses. The purpose of this study is to address the difficulties of recording contact forces with available sensors. Ten participants walked 5 times wearing two different types of footwear by stepping on a pressure platform (ground contact forces) while wearing in-shoe pressure sensors (foot sole contact forces). Pressure data were segmented by considering contact cells' anteroposterior location, and were used to compute 3D moments at foot joints. The mean values and 95% confidence intervals were plotted for each device per shoe condition. The peak values and times of forces and moments were computed per participant and trial under each condition, and were compared using mixed-effect tests. Test-retest reliability was analyzed by means of intraclass correlation coefficients. The curve profiles from both devices were similar, with higher joint moments for the instrumented insoles at the metatarsophalangeal joint (~26%), which were lower at the ankle (~8%) and midtarsal (~15%) joints, although the differences were nonsignificant. Not considering frictional forces resulted in ~20% lower peaks at the ankle moments compared to previous studies, which employed force plates. The device affected both shoe conditions in the same way, which suggests the interchangeability of measuring joint moments with one or the other device. This hypothesis was reinforced by the intraclass correlation coefficients, which were higher for the peak values, although only moderate-to-good. In short, both considered alternatives have drawbacks. Only the instrumented in-soles provided direct information about foot contact forces, but it was incomplete (evidenced by the difference in ankle moments between devices). However, recording ground reaction forces offers the advantage of enabling the consideration of contact friction forces (using force plates in series, or combining a pressure platform and a force plate to estimate friction forces and torque), which are less invasive than instrumented insoles (which may affect subjects' gait).
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Affiliation(s)
- Joaquín L. Sancho-Bru
- Department of Mechanical Engineering and Construction, Universitat Jaume I, 12071 Castellón de la Plana, Spain;
| | - Enrique Sanchis-Sales
- Departmental Section of Podiatry, Nursing Department, Universitat de València, 46010 Valencia, Spain;
| | | | - Carles Vergés-Salas
- Departmental Section of Podiatry, Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain;
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8
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Queen RM, Schmitt D. Reflections on Presurgical and Postsurgical Gait Mechanics After 50 Years of Total Ankle Arthroplasty and Perspectives on the Next Decade of Advancement. Foot Ankle Clin 2023; 28:99-113. [PMID: 36822691 DOI: 10.1016/j.fcl.2022.10.005] [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
Although not the most prevalent form of lower limb pathology, ankle arthritis is one of the most painful and life-limiting forms of arthritis. Developing from overuse and various traumatic injuries, the effect of ankle arthritis on gait mechanics and effective treatment options for ankle arthritis remain an area of extensive inquiry. Although nonsurgical options are common (physical therapy, limited weight-bearing, and steroidal injections), surgical options are popular with patients. Fusion remains a common approach to stabilize the joint and relieve pain. However, starting in the early 1970s, total ankle arthroplasty was proposed as an alternative to fusion.
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Affiliation(s)
- Robin M Queen
- Department of Biomedical Engineering and Mechanics, Kevin P. Granata Biomechanics Lab, Blacksburg, VA, USA; Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
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Ramaskandhan J, Kakwani R, Kometa S, Hewart P, Rawlings D, Chockalingam N, Siddique M. Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement. J Foot Ankle Surg 2023:S1067-2516(22)00370-2. [PMID: 36710141 DOI: 10.1053/j.jfas.2022.12.005] [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] [Received: 12/04/2020] [Revised: 06/09/2021] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.
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Affiliation(s)
- Jayasree Ramaskandhan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
| | - Rajesh Kakwani
- Department of Orthopaedics, Northumbria Healthcare NHS Trust, North Shields, UK
| | - Simon Kometa
- Newcastle University IT (NUIT) Service, Newcastle upon Tyne, UK
| | - Penny Hewart
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - David Rawlings
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Malik Siddique
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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Renner K, Delaney C, Hill C, Sands L, Queen R. Predicting post-total ankle arthroplasty walking speed based on preoperative gait mechanics. J Orthop Res 2022; 41:1070-1075. [PMID: 36116022 DOI: 10.1002/jor.25444] [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] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Decreased walking speed is associated with impaired physical performance and function in older adults. Following total ankle arthroplasty (TAA), walking speed continues to be slower than age matched controls. The purpose of this study was to determine if patients 1 year post-TAA can achieve walking speed benchmarks and investigate if gait metrics are predictive of achieved benchmarks. 191 TAA patients were recruited and assessed pre-TAA and 1 year post-TAA. Kinetic and kinematic data were collected during seven self-selected speed barefoot walking trials along a 30-m walkway. Receiver operator curves were generated for each variable to determine threshold values needed to achieve walking speeds of 0.8, 0.9, 1.1, and 1.3 m/s. Each variable's predictive ability was classified according to the area under the curve. Ninety one percent of participants achieved a walking speed > 0.8 m/s, 85.3% achieved ≥0.9 m/s, 64.9% walked at ≥1.1 m/s, and 24.1% achieved a walking speed of 1.3 m/s by 1 year post-TAA. Walking speed pre-TAA was the strongest predictor with ankle moment, power and GRF data showing mixed results. Clinical Significance: 75.9% of participants were unable to walk at 1.3 m/s-a speed indicative of safely crossing a street. Variables predictive of postoperative walking speed benchmarks could be useful in developing interventions for the TAA population. The strongest predictor across all walking speed benchmarks was preoperative walking speed. A walking speed > 0.71 m/s was predictive of achieving 0.8 m/s 1 year post-TAA, while >1.09 m/s predicted 1.3 m/s 1 year post-TAA.
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Affiliation(s)
- Kristen Renner
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Caitlyn Delaney
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Cherice Hill
- Clemson University-Medical University of South Carolina Joint Bioengineering Program, Charleston, South Carolina, USA
| | - Laura Sands
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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11
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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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12
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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]
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13
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Dahmen J, Altink JN, Vuurberg G, Wijdicks CA, Stufkens SAS, Kerkhoffs GMMJ. Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus. World J Orthop 2022; 13:178-192. [PMID: 35317406 PMCID: PMC8891659 DOI: 10.5312/wjo.v13.i2.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.
AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.
METHODS This is a prospective study during which patients were assessed preoperatively, at 2- and 6 wk, and at 3, 6, 12 and 24 mo postoperatively. Patients with multiple, cystic or large (≥ 15 mm) osteochondral lesions of the talus after failed prior surgery were included. The primary outcome measure was the numeric rating scale (NRS) for pain during walking at 2 years postoperatively. Secondary outcome measures included the NRS in rest and during stair climbing, the American Orthopaedic Foot and Ankle Society Hindfoot Score, the Foot and Ankle Outcome Score, the Short- Form 36 physical and mental component scale, and the Range of Motion (ROM). Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence. Revision rates and complications were also assessed.
RESULTS Two patients underwent an Ankle Spacer implantation on the talus. The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years, in patient 1 and 2, respectively. The other patient-reported outcome measures also improved substantially. There were no re-operations nor complications. Radiological imaging showed no loosening of the implant and no change of implant position.
CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking, improvement in clinical outcomes as assessed with PROMs, and no complications or re-operations. This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - J Nienke Altink
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Coen A Wijdicks
- Department of Orthopedic Research, Arthrex, Naples, FL 34108, United States
| | - Sjoerd AS Stufkens
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
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14
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Hill CN, Ross S, Peebles A, Queen RM. Continuous similarity analysis in patient populations. J Biomech 2021; 131:110916. [PMID: 34952349 DOI: 10.1016/j.jbiomech.2021.110916] [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: 12/02/2020] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Decreased movement symmetry is associated with injury risk and accelerated disease progression. Methods to analyze continuous data either cannot be used in pathologic populations with abnormal movement patterns or are not defined in terms easily incorporated into clinical care. The purpose of this study was to develop a method of describing symmetry and movement quality in continuous time-series data that results in scores that can be readily incorporated into clinical care. Two scores were developed: (1) the symmetry score (SS) which evaluates similarities in time-series data between limbs and (2) the closeness-to-healthy score (CTHS) which evaluates the similarity of time-series data to a control population. Kinetic and kinematic data from 56 end-stage unilateral ankle arthritis (A-OA) patients and 56 healthy older adults, along with 16 anterior cruciate ligament reconstruction (ACLR) patients and 16 healthy young adults were used to test the ability for SS and CTHS to differentiate between healthy and patient groups. Unpaired t-tests, Cohen's D effect sizes, and receiver-operating-curve analyses assessed group differences [SPSS, V27, α = 0.05]. Patients had worse SS than controls and A-OA patients had worse CTHS compared to controls. SS had strong predictive capability, while the predictive capability of CTHS varied. Combined with clinically accessible data collection methods, the SS and CTHS could be used to evaluate patients' baseline movement quality, assess changes due to disease progression, and during recovery. Results could be utilized in clinical decision making to assess surgical intervention urgency and efficacy of surgical interventions or rehabilitation protocols to improve side-to-side limb symmetry.
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Affiliation(s)
- Cherice N Hill
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Shane Ross
- Department of Aerospace and Ocean Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alexander Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
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15
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Zeininger A, Schmitt D, Hughes-Oliver C, Queen RM. The effect of ankle osteoarthritis and total ankle arthroplasty on center of pressure position. J Orthop Res 2021; 39:1245-1252. [PMID: 32918492 DOI: 10.1002/jor.24857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Total ankle arthroplasty (TAA) is a common surgical approach for patients with end-stage ankle osteoarthritis (OA). However, very little is known about the path of the center of pressure (COP) of the foot, and thus important aspects of load transfer, muscle mechanical advantage, and balance, in patients before or after surgery. The objective of this study was to trace the pathway of the COP under the foot in patients with symptomatic ankle OA, comparing asymmetry between affected and unaffected limbs. From force plate data, proximodistal and mediolateral positions of the COP beneath the foot were calculated and compared for the affected and unaffected foot in patients with unilateral ankle OA (N = 93) before and after TAA. Gender and age at surgery had little or no effect in this study. Patients with ankle OA had minimal COP position asymmetry before surgery, and this asymmetry was reduced following surgery. Before surgery, patients had a slower walking speed and a shorter path of the COP which began relatively distal to the heel and ended relatively proximal to the hallux. TAA increased the proximodistal distance the COP traveled under both the unaffected and affected foot, a pattern that was maintained for over 2-year postsurgery. TAA allows patients with ankle OA to maintain a longer COP path than they had before surgery on both sides that is closer to that reported for unaffected individuals, extending effectively from the heel to the hallux, potentially improving pedal mechanics.
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Affiliation(s)
- Angel Zeininger
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
| | - Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
| | - Cherice Hughes-Oliver
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Robin M Queen
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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16
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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.
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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
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17
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Brodsky JW, Jaffe D, Pao A, Vier D, Taniguchi A, Daoud Y, Coleman S, Scott DJ. Long-term Functional Results of Total Ankle Arthroplasty in Stiff Ankles. Foot Ankle Int 2021; 42:527-535. [PMID: 33554643 DOI: 10.1177/1071100720977847] [Citation(s) in RCA: 9] [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 Total ankle arthroplasty (TAA) is advocated over ankle arthrodesis to preserve ankle motion (ROM). Clinical and gait analysis studies have shown significant improvement after TAA. The role and outcomes of TAA in stiff ankles, which have little motion to be preserved, has been the subject of limited investigation. This investigation evaluated the mid- to long-term functional outcomes of TAA in stiff ankles. METHODS A retrospective study of prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 (5-13) years postoperatively used 1-way analysis of variance and multivariate regression analysis to compare among preoperative and postoperative demographic data (age, gender, body mass index, years postsurgery, and diagnosis) and gait parameters according to quartiles of preoperative sagittal ROM. RESULTS The stiffest ankles had a mean ROM of 7.8 degrees, compared to 14.3 degrees for the middle 2 quartiles, and 21.0 degrees for the most flexible ankles. Patients in the lowest quartile (Q1) also had statistically significantly lower step length, speed, max plantarflexion, and power preoperatively. Postoperatively, they increased step length, speed, max plantarflexion, and ankle power to levels comparable to patients with more flexible ankles preoperatively (Q2, Q3, and Q4). They had the greatest absolute and relative increases in these parameters of any group, but the final total ROM was still statistically significantly the lowest. CONCLUSION Preoperative ROM was predictive of overall postoperative gait function at an average of 7.6 (range 5-13) years. Although greater preoperative sagittal ROM predicted greater postoperative ROM, the stiffest ankles showed the greatest percentage increase in ROM. Patients with the stiffest ankles had the greatest absolute and relative improvements in objective function after TAA, as measured by multiple gait parameters. At intermediate- to long-term follow-up, patients with stiff ankles maintained significant functional improvements after TAA. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | | | - Andrew Pao
- Department of Orthopedic Surgery, Crystal Run Healthcare, Middletown, NY, USA
| | - David Vier
- Baylor University Medical Center, Dallas, TX, USA
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yahya Daoud
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Daniel J Scott
- Medical University of South Carolina, Charleston, SC, USA
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18
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Timeline for maximal subjective outcome improvement following total ankle arthroplasty. Foot Ankle Surg 2021; 27:305-310. [PMID: 32565023 DOI: 10.1016/j.fas.2020.05.012] [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] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Maximal medical improvement (MMI) establishes the timepoint when patients no longer experience clinically significant improvements following surgery. The purpose of this investigation is to establish when patients achieve MMI following total ankle arthroplasty (TAA) through the use of patient reported outcome measures (PROMs). METHODS A systematic review to identify studies on TAA which reported consecutive PROMs for two years postoperatively was performed. Pooled analysis was done at 6 months, 12 months, and 24 months. Clinically significant improvement was defined as improvement between time intervals exceeding the minimal clinically important difference. RESULTS Twelve studies and 1514 patients met inclusion criteria. Clinically significant improvement was seen up to 6 months postoperatively in both the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Score and Visual Analog Scale scoring systems. The Short Musculoskeletal Function Assessment Dysfunction and Bother subsections showed maximal clinically significant improvement by 1 year postoperatively. CONCLUSION Following TAA, MMI is seen by one year postoperatively. Physicians may allocate the majority of resources within the first year when most of the improvement is perceived. This data may help inform preoperative counseling as it establishes a timeline for MMI. LEVEL OF EVIDENCE IV.
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19
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Brodsky JW, Scott DJ, Ford S, Coleman S, Daoud Y. Functional Outcomes of Total Ankle Arthroplasty at a Mean Follow-up of 7.6 Years: A Prospective, 3-Dimensional Gait Analysis. J Bone Joint Surg Am 2021; 103:477-482. [PMID: 33464768 DOI: 10.2106/jbjs.20.00659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In vivo gait analysis provides objective measurement of patient function and can quantify that function before and after ankle reconstruction. Previous gait studies have shown functional improvement for up to 4 years following total ankle arthroplasty (TAA), but to date, there are no published studies assessing function at ≥5 years following TAA. We hypothesized that patients who underwent TAA would show significant improvements in walking function at a minimum follow-up of 5 years, compared with their preoperative function, as measured by changes in temporospatial, kinematic, and kinetic gait parameters. METHODS Three-dimensional gait analysis with a 12-camera digital motion-capture system and double force plates was utilized to record temporospatial, kinematic, and kinetic measures in 33 patients who underwent TAA with either the Scandinavian Total Ankle Replacement (Stryker; n = 28) or Salto Talaris Ankle (Integra LifeSciences; n = 5). Gait analysis was performed preoperatively and at a minimum follow-up of 5 years (mean, 7.6 years; range, 5 to 13 years). RESULTS Significant improvements were observed in multiple gait parameters, with temporospatial increases in cadence (+9.5 steps/min; p < 0.0001), step length (+4.4 cm; p = 0.0013), and walking speed (+0.2 m/s; p < 0.0001), and kinematic increases in total sagittal range of motion (+2.0°; p = 0.0263), plantar flexion at initial contact (+2.7°; p = 0.0044), and maximum plantar flexion (+2.0°; p = 0.0488). Kinetic analysis revealed no loss of peak ankle power, despite patients aging. CONCLUSIONS To our knowledge, this is the first study to report 7-year functional outcomes of TAA, quantified by objective, in vivo measurements of patient gait. Patients were shown to have sustained improvement in multiple objective parameters of gait compared with preoperative function. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Daniel J Scott
- Medical University of South Carolina, Charleston, South Carolina
| | - Samuel Ford
- Baylor University Medical Center, Dallas, Texas
| | | | - Yahya Daoud
- Baylor University Medical Center, Dallas, Texas
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20
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Wade FE, Hickox LJ, Lewis GS, Horne A, Aynardi MC, Juliano PJ, Aydogan U, Piazza SJ. Achilles tendon moment arm changes with total ankle arthroplasty. J Orthop Res 2021; 39:572-579. [PMID: 33222251 DOI: 10.1002/jor.24922] [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] [Received: 06/23/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
Prior research on total ankle arthroplasty (TAA) has focused on improvements in pain and function following the surgical treatment of ankle arthritis, but its effect on ankle joint mechanics has received relatively little attention. The plantarflexion moment arm of the Achilles tendon is a critical determinant of ankle function with the potential to be altered by TAA. Here we investigate the effect of TAA on Achilles tendon moment arm assessed using two methods. Standing sagittal-plane radiographs were obtained for ten patients presurgery and postsurgery, from which anterior-posterior distance between the posterior calcaneus and the center of the talar dome was measured. Ultrasound imaging and three-dimensional (3D) motion capture were used to obtain moment arm pre- and post-TAA. The absolute changes in moment arm pre- to post-TAA were significantly different from zero for both methods (9.6 mm from ultrasound and 4.6% of the calcaneus length from radiographs). Only 46% of the variance in postoperative 3D Achilles tendon moment arm was explained by the preoperative value (r2 = 0.460; p = .031), while pre- and post-TAA values from radiographs were not correlated (r2 = 0.192, p = .206). While we did not find significant mean differences in Achilles tendon moment arm between pre- and post-TAA, we did find absolute changes in 3D moment arm that were significantly different from zero and these changes were partially explained by a change in location of the talar dome as indicated by measurements from radiographs (r2 = 0.497, p = .023).
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Affiliation(s)
- Francesca E Wade
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lauren J Hickox
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Gregory S Lewis
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andrea Horne
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Michael C Aynardi
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Paul J Juliano
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Umur Aydogan
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Mechanical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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21
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Sanders AE, Kraszewski AP, Ellis SJ, Queen R, Backus SI, Hillstrom H, Demetracopoulos CA. Differences in Gait and Stair Ascent After Total Ankle Arthroplasty and Ankle Arthrodesis. Foot Ankle Int 2021; 42:347-355. [PMID: 33198507 DOI: 10.1177/1071100720965144] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ankle arthrodesis has historically been the standard of care for end-stage ankle arthritis; however, total ankle arthroplasty (TAA) is considered a reliable alternative. Our objective was to compare 3-dimensional foot and ankle kinetics and kinematics and determine the ankle power that is generated during level walking and stair ascent between TAA and ankle arthrodesis patients. METHODS Ten patients who underwent TAA with a modern fixed-bearing ankle prosthesis and 10 patients who previously underwent ankle arthrodesis were recruited. Patients were matched for age, sex, body mass index, time from surgery, and preoperative diagnosis. A minimum of 2-year follow-up was required. Patients completed instrumented 3D motion analysis while walking over level ground and during stair ascent. Between-group differences were assessed with a 2-tailed Mann-Whitney exact test for 2 independent samples. RESULTS Sagittal ankle range of motion (ROM) was significantly higher in the TAA group (21.1 vs 14.7 degrees, P = .003) during level walking. In addition, forefoot-tibia motion (25.3±5.9 degrees vs 18.6±5.1 degrees, P = .015) and hindfoot-tibia motion (15.4±3.2 degrees vs 12.2±2.5 degrees, P = .022) were significantly greater in the TAA group. During stair ascent, sagittal ankle ROM (25 vs 17.1 degrees, P = .026), forefoot-tibia motion (27.6 vs 19.6 degrees, P = .017), and hindfoot-tibia motion (16.8 vs 12 degrees, P = .012) was greater. CONCLUSION There were significant differences during level walking and stair ascent between patients with TAA and ankle arthrodesis. TAA patients generated greater peak plantarflexion power and sagittal motion within the foot and ankle compared to patients with an ankle arthrodesis. Further investigation should continue to assess biomechanical differences in the foot and ankle during additional activities of daily living. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Austin E Sanders
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew P Kraszewski
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Robin Queen
- Kevin Granata Biomechanics Lab, Department of Biomedical Engineering & Mechanics, Virginia Tech, Blacksburg, VA, USA.,Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Sherry I Backus
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
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22
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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.
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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.
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23
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Lullini G, Caravaggi P, Leardini A, Ortolani M, Mazzotti A, Giannini S, Berti L. Retrospective comparison between a two- and three-component ankle arthroplasty: clinical and functional evaluation via gait analysis. Clin Biomech (Bristol, Avon) 2020; 80:105180. [PMID: 32992079 DOI: 10.1016/j.clinbiomech.2020.105180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle arthroplasty is intended to restore physiological joint function in case of severe ankle arthritis. However, little is known about the functional outcome associated to different prosthesis designs. The aim of this retrospective study was to compare clinical and functional outcomes via gait analysis of two ankle prostheses designed to preserve ankle ligamentous isometry. METHODS Two groups of twenty patients who underwent ankle arthroplasty using either a three-component or a two-component prosthesis, were clinically evaluated, both pre-operatively and at minimal 2-year follow-up, by means of the AOFAS score. The spatio-temporal parameters, along with the kinetics and kinematics of the lower limb joints were also assessed at follow-up via gait analysis. The non-parametric Kruskal-Wallis test was used to assess differences in functional data between the two patient groups and with respect to those from a control group of 20 healthy subjects. FINDINGS All AOFAS scores significantly improved from pre-operative to post-operative assessment in both patient groups (P < 0.05). Most spatio-temporal and functional parameters in the patients were worse than those in the control group, but no significant differences were observed between the two arthroplasty groups. INTERPRETATION Both patient groups showed improved clinical outcome at follow-up, with a few differences in gait parameters. However, neither of the two groups achieved normal locomotion patterns. Since both prostheses were designed to preserve ligamentous isometry, the choice of one implant over the other should be due to preferences in the surgical approach and to other patient-specific factors.
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Affiliation(s)
- Giada Lullini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sandro Giannini
- Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli & Università di Bologna, Bologna, Italy
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Johns WL, Sowers CB, Walley KC, Ross D, Thordarson DB, Jackson JB, Gonzalez TA. Return to Sports and Activity After Total Ankle Arthroplasty and Arthrodesis: A Systematic Review. Foot Ankle Int 2020; 41:916-929. [PMID: 32501110 DOI: 10.1177/1071100720927706] [Citation(s) in RCA: 8] [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 There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). This systematic review summarizes the evidence on return to sports and activity after operative management with either TAR or AA for ankle osteoarthritis (OA). METHODS A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed. Risk of bias of included studies was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. Included studies reported sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being the percentage of sports participation and level of sports participation. RESULTS Twelve studies met inclusion criteria for analysis. There were 1270 ankle procedures, of which 923 TAR and 347 AA were performed. The mean reported patient age was 59.2 years and the mean BMI was 28 kg/m2. The mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared with 63.7% postoperatively. The mean preoperative activity participation rate was 41% in the TAR cohort, but it improved to 59% after TAR, whereas the preoperative activity participation rate of 73% was similar to the postoperative rate of 70% in the AA cohort. The most common sports in the TAR and AA groups were swimming, hiking, cycling, and skiing. CONCLUSION Participation in sports activity was nearly 10% improved after operative management of ankle OA with TAR and remains high after AA. The existing literature demonstrated a large improvement in pre- to postoperative activity levels after TAR, with minimal change in activity after AA; however, AA patients were more active at baseline. The most frequent postoperative sports activities after operative management of ankle OA were swimming, hiking, cycling, and skiing. Participation in high-impact sports such as tennis, soccer, and running was consistently limited after surgery. This review of the literature will allow patients and foot and ankle surgeons to set evidence-based goals and establish realistic expectations for postoperative physical activity after TAR and AA. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- William L Johns
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Daniel Ross
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | | | | | - Tyler A Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
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Smyth NA, Kennedy JG, Parvizi J, Schon LC, Aiyer AA. Risk factors for periprosthetic joint infection following total ankle replacement. Foot Ankle Surg 2020; 26:591-595. [PMID: 31427149 DOI: 10.1016/j.fas.2019.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Identifying preoperative patient characteristics that correlate with an increased risk of periprosthetic joint infection (PJI) following total ankle replacement (TAR) is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR. METHODS Utilizing the terms "(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)" we searched the PubMed/MEDLINE electronic databases. The quality of the included studies was then assessed using the AAOS Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence. RESULTS Eight studies met the inclusion criteria. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age less than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery. CONCLUSIONS Several risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.
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Affiliation(s)
- Niall A Smyth
- Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, United States.
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, New York, NY 10002, United States
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA 19107, United States
| | - Lew C Schon
- Department of Orthopaedic Surgery, Medstar Union Memorial, 3333 N Calvert St, Baltimore, MD 21218, United States
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1611 NW 12(th) Ave, Miami, FL 33136, United States
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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.
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Saito GH, Sturnick DR, Ellis SJ, Deland JT, Demetracopoulos CA. Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait. Foot Ankle Int 2019; 40:873-879. [PMID: 31244338 DOI: 10.1177/1071100719858620] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ankle and hindfoot kinematics following total ankle arthroplasty (TAA) are poorly understood and it is unclear whether patients can replicate physiologic motion after TAA. Furthermore, the effect of implant position on TAA kinematics is unknown. The objective of this study was to compare ankle and hindfoot kinematics pre- and post-TAA during simulated gait and determine to what degree tibial component position correlated with variations in ankle kinematics. METHODS Eight midtibia cadaveric specimens were utilized in this institutional review board-approved study. The stance phase of gait was simulated both pre- and post-TAA in each specimen using a 6 degrees of freedom robotic platform. Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. The effect of tibial component position on absolute differences in ankle kinematics was assessed using linear regression. RESULTS No differences were observed in ankle sagittal and coronal plane motion between the intact and TAA conditions. Differences in ankle joint kinematics were identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared with the native condition. The medial-lateral position of the tibial component was found to correlate with the altered transverse plane motion observed after TAA (β = 1.861 degrees/mm, R2 = 0.72, P = .008). No significant differences in subtalar and talonavicular joint kinematics in any plane were observed comparing the pre- and post-TAA condition. CONCLUSION This study demonstrated an increased internal rotation of the ankle in the transverse plane following TAA. This increase was correlated with the medial-lateral position of the tibial implant. CLINICAL RELEVANCE This finding could have clinical implications for how tibial components are positioned during the operative procedure, and how implant design and position may affect ankle kinematics following TAA.
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Affiliation(s)
- Guilherme H Saito
- 1 Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel R Sturnick
- 2 Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- 1 Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- 1 Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Escudero MI, Poggio D, Alvarez F, Barahona M, Vivar D, Fernandez A. Tibiotalocalcaneal arthrodesis with distal tibial allograft for massive bone deficits in the ankle. Foot Ankle Surg 2019; 25:390-397. [PMID: 30321970 DOI: 10.1016/j.fas.2018.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess the outcomes of distal tibial structural allograft to obtain a stable TTC fusion. METHODS Retrospectively, ten patients were carried out with a minimum one year follow-up. The median age was 72 (33-81). The median BMI was 28 (24-33). Indications for TTC arthrodesis included failed total ankle arthroplasty (n=7 patients), prior nonunion (n=2 patients), and a trauma injury. RESULTS Union rate was 80%. The median initial height of the distal tibial allograft was 19mm (14-24mm). In seven cases the allograft did not lose height. The AOFAS score median was 69 (31-84). SF-12 median physical component was 39 (30-53), and 59 (23-62) for mental component. The VAS median was 2 (0-8). CONCLUSIONS TTC using distal tibial allograft shows a lower rate of collapse than other structural grafts and provides a fusion rate higher or in accordance with the literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile.
| | - Daniel Poggio
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Fernando Alvarez
- Department of Orthopedics, Hospital San Rafael, Passeig de la Vall d'Hebron, 107, 08035 Barcelona, Spain
| | - Maximiliano Barahona
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile
| | - Diego Vivar
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Alvaro Fernandez
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
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Dekker TJ, Hamid KS, Federer AE, Steele JR, Easley ME, Nunley JA, Adams SB. The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement. Foot Ankle Spec 2018; 11:451-456. [PMID: 29277111 DOI: 10.1177/1938640017750258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated patient-reported outcome measures (PROMs) in individuals receiving TAR. METHODS Patients undergoing TAR at a single academic medical center between 2007 and 2013 were evaluated in this study. In addition to a minimum of 2-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS), and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. RESULTS Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up ( P < .01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS, and SMFA Function ( P < .05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. CONCLUSION In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains when evaluating final total range of motion. Patients who undergo TAR for end-stage osteoarthritis with improvement in ROM demonstrate a direct correlation with improved patient-centric metrics and outcome scores. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Travis J Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andrew E Federer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - John R Steele
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Hughes-Oliver CN, Srinivasan D, Schmitt D, Queen RM. Gender and limb differences in temporal gait parameters and gait variability in ankle osteoarthritis. Gait Posture 2018; 65:228-233. [PMID: 30558936 DOI: 10.1016/j.gaitpost.2018.07.180] [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: 04/17/2018] [Revised: 06/19/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effects of ankle osteoarthritis on gait are noticeable in the clinic, but are difficult to quantify and score without detailed kinematic and kinetic analysis. Evaluationof temporal gait parameters and gait variability is a potential alternative. RESEARCH QUESTION This study aimed to determine associations between limb and gender with temporal gait parameters and gait variability in ankle OA patients to evaluate the utility of these parameters for gait assessment in a clinical setting. METHODS Following informed consent, 242 end-stage unilateral ankle OA patients walked at self-selected speed across force plates. Means and stride-to-stride standard deviations (SD) of stride, swing, stance, and double support times were determined for each patient. Limb x Gender ANCOVA models co-varying for walking speed were run for swing and stance times, while stride and double support times were only compared between genders. Statistical analysis was performed in SPSS (α = 0.05). RESULTS Walking speed affected all measures of interest. After adjusting for walking speed, mean stride time, stride time SD, and stance time SD were 3.5%, 67% and 29% higher among women than men (p = 0.002, 0.035 and 0.02 respectively). Swing time was 12% higher and stance time was 6% lower on the affected side compared to the unaffected side (p < 0.001 for both). SIGNIFICANCE Women have longer stride times and higher variability, which may indicate higher fall risk. Both genders minimized loading on the affected limb by increasing swing time and reducing stance time on the affected side. Simple, easy to record temporal gait patterns can provide useful insight into gait abnormalities in patients with ankle OA.
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Affiliation(s)
- C N Hughes-Oliver
- Department of Biomedical Engineering and Mechanics, 495 Old Turner Street Blacksburg, VA, 24060, 208 Norris Hall, USA.
| | - D Srinivasan
- Department of Industrial Systems Engineering, 1185 Perry Street Blacksburg, VA, 24060, 549 Whittemore Hall, USA.
| | - D Schmitt
- Department of Evolutionary Anthropology, 130 Science Drive, Durham, NC, 27708, 203 Biological Sciences Building, USA.
| | - R M Queen
- Department of Biomedical Engineering and Mechanics, 495 Old Turner Street Blacksburg, VA, 24060, 230 Norris Hall, USA.
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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.
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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
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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.
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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
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Wellman SS, Klement MR, Queen RM. Performance Comparison of Single-Radius Versus Multiple-Curve Femoral Component in Total Knee Arthroplasty: A Prospective, Randomized Study Using the Lower Quarter Y-Balance Test. Orthopedics 2017; 40:e1074-e1080. [PMID: 29116326 DOI: 10.3928/01477447-20171020-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 02/03/2023]
Abstract
Midflexion stability after total knee arthroplasty (TKA) is dependent, in part, on implant design. Midflexion performance of a single-radius (SR) design and a multi-radius, or J-curve (JC), design were compared using the Lower Quarter Y-Balance Test (YBT-LQ). Patient-reported outcomes and measures of physical performance were also compared. The authors hypothesized that the SR design would provide superior midflexion stability and, therefore, a greater reach distance in the YBT-LQ when compared with the JC design. Patients undergoing primary, unilateral TKA were prospectively enrolled and block randomized to receive either the SR (n=30) or the JC (n=30) implant. Patients reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Knee Society Score, and University of California at Los Angeles Activity Score), performed the YBT-LQ, and completed physical performance measures (walking speed, timed up-and-go test, and sit-to-stand test) before surgery and 1 year postoperatively. One year postoperatively, 40 patients (20 SR, 20 JC) were available for analysis. There were no significant differences between the groups regarding age, sex, body mass index, American Society of Anesthesiologists score, YBT-LQ results, or any other variable of interest. In both groups, significant improvements were observed for all variables of interest when compared from preoperatively to 1 year postoperatively. Implant type did not affect patient-reported or physical performance outcomes following TKA; however, patients showed significant improvement in most outcome measures by 1 year postoperatively. The significant limitations in strength and balance in this cohort of patients likely outweigh any subtle differences in implant design. [Orthopedics. 2017; 40(6):e1074-e1080.].
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Queen R. Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty. J Orthop Res 2017; 35:2345-2355. [PMID: 28543369 DOI: 10.1002/jor.23609] [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] [Received: 01/03/2017] [Accepted: 05/12/2017] [Indexed: 02/04/2023]
Abstract
Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017.
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Affiliation(s)
- Robin Queen
- Kevin Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, Virginia, 24061
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Abstract
BACKGROUND The decision tree for the operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). Although both have documented success providing diminished pain, improved patient-centered outcomes, and improved objective measures of function, arthroplasty is unique in its ability to preserve motion at the tibiotalar joint. Arthroplasty procedures are normally thought of as a motion-sparing surgery rather than a motion-producing procedure, which may limit its success in patients with stiff ankles. Our hypothesis was that there would be improvements in parameters of gait even in patients with a low degree of preoperative total sagittal range of motion. METHODS A retrospective review was conducted on patients who underwent total ankle arthroplasty with greater than 1-year follow-up. Seventy-six patients were available who underwent isolated TAA for end-stage ankle arthritis with greater than 1-year follow-up. Patient demographics and preoperative and postoperative gait analyses were evaluated. Using a linear regression model, the effect sizes for the variables of age, gender, BMI, preoperative diagnosis, and preoperative total sagittal range of motion were calculated. Multivariate analysis was used to determine the influence each individual variable had on the many parameters of preoperative gait, postoperative gait, and change in gait after surgery. A post hoc analysis was conducted in which patients were divided into 4 quartiles according to preoperative range of motion. A 1-way analysis of variance (ANOVA) was used to compare improvement in parameters of gait for the 4 subgroups. RESULTS Although a greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion, patients with limited preoperative range of motion experienced a greater overall improvement in range of motion, and clinically meaningful absolute improvements in range of motion, and other parameters of gait. The post hoc analysis demonstrated that patients in the lowest quartile of preoperative motion had both statistically and clinically significant greater improvements across numerous parameters of gait, although the absolute values were lower than in the patients with higher preoperative ROM. Age, gender, BMI, and preoperative diagnosis did not correlate with changes in parameters of gait after total ankle arthroplasty. CONCLUSION Preoperative range of motion was predictive of overall postoperative gait function. On one hand, a low preoperative range of motion resulted in a lower absolute postoperative function. On the other hand, patients with stiff ankles preoperatively had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This suggests that total ankle arthroplasty can offer clinically meaningful improvement in gait function and should be considered for patients with end-stage tibiotalar arthritis even in the setting of limited sagittal range of motion. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- James W Brodsky
- 1 Baylor University Medical Center, Dallas, TX, USA.,2 University of Texas Southwestern Medical School, Dallas, TX, USA.,3 College of Medicine, Texas A&M University Health Science Center, Bryan, TX, USA
| | | | - Akira Taniguchi
- 4 Department of Orthopaedic Surgery, Nara Medical University, Kashihara-shi, Nara-ken, Japan
| | | | - Yahya Daoud
- 5 Quantitative Sciences and Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX, USA
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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.
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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
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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.
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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
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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.
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Sanchis-Sales E, Sancho-Bru JL, Roda-Sales A, Pascual-Huerta J. 3D characterisation of the dynamics of foot joints of adults during walking. Gait pattern identification. Comput Methods Biomech Biomed Engin 2017; 20:1015-1030. [PMID: 28521518 DOI: 10.1080/10255842.2017.1331343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A detailed description of the kinematics and kinetics of the ankle, midtarsal and metatarsophalangeal joints of the feet of a healthy adult male population during barefoot walking is provided. Plots of the angles and moments in each plane during the stance phase are reported, along with the mean and standard deviation values of 87 different parameters that characterise the 3D dynamics of the foot joints. These parameters were used to check for similarities between subjects through a hierarchical analysis that allowed three different gait patterns to be identified, most of the differences corresponding to the frontal and transverse planes.
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Affiliation(s)
- E Sanchis-Sales
- a Department de Podologia , Universitat de València , València , Spain
| | - J L Sancho-Bru
- b Department d'Enginyeria Mecànica i Construcció , Universitat Jaume I , Castelló , Spain
| | - A Roda-Sales
- b Department d'Enginyeria Mecànica i Construcció , Universitat Jaume I , Castelló , Spain
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40
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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.
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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
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Queen RM, Sparling TL, Schmitt D. Hip, Knee, and Ankle Osteoarthritis Negatively Affects Mechanical Energy Exchange. Clin Orthop Relat Res 2016; 474:2055-63. [PMID: 27287859 PMCID: PMC4965381 DOI: 10.1007/s11999-016-4921-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individuals with osteoarthritis (OA) of the lower limb find normal locomotion tiring compared with individuals without OA, possibly because OA of any lower limb joint changes limb mechanics and may disrupt transfer of potential and kinetic energy of the center of mass during walking, resulting in increased locomotor costs. Although recovery has been explored in asymptomatic individuals and in some patient populations, the effect of changes in these gait parameters on center of mass movements and mechanical work in patients with OA in specific joints has not been well examined. The results can be used to inform clinical interventions and rehabilitation that focus on improving energy recovery. QUESTIONS/PURPOSES We hypothesized that (1) individuals with end-stage lower extremity OA would exhibit a decrease in walking velocity compared with asymptomatic individuals and that the joint affected with OA would differntially influence walking velocity, (2) individuals with end-stage lower extremity OA would show decreased energy recovery compared with asymptomatic individuals and that individuals with end-stage hip and ankle OA would have greater reductions in recovery than would individuals with end-stage knee OA owing to restrictions in hip and ankle motion, and (3) that differences in the amplitude and congruity of the center of mass would explain the differences in energy recovery that are observed in each population. METHODS Ground reaction forces at a range of self-selected walking speeds were collected from individuals with end-stage radiographic hip OA (n = 27; 14 males, 13 females; average age, 55.6 years; range, 41-70 years), knee OA (n = 20; seven males, 13 females; average age, 61.7 years; range, 49-74 years), ankle OA (n = 30; 14 males, 16 females; average age, 57 years; range, 45-70 years), and asymptomatic individuals (n = 13; eight males, five females; average age, 49.8 years; range, 41-67 years). Participants were all patients with end-stage OA who were scheduled to have joint replacement surgery within 4 weeks of testing. All patients were identified by the orthopaedic surgeon as having end-stage radiographic disease and to be a candidate for joint replacement surgery. Patients were excluded if they had pain at any other lower extremity joint, previous joint replacement surgery, or needed to use an assistive device for ambulation. Patients were enrolled if they met the study inclusion criteria. Our study was comparative and cohorts could be compared with each other, however, the asymptomatic group served to verify our methods and provided a recovery standard with which we could compare our patients. Potential and kinetic energy relationships (% congruity) and energy exchange (% recovery) were calculated. Linear regressions were used to examine the effect of congruity and amplitude of energy fluctuations and walking velocity on % recovery. Analysis of covariance was used to compare energy recovery between groups. RESULTS The results of this study support our hypothesis that individuals with OA walk at a slower velocity than asymptomatic individuals (1.4 ± 0.2 m/second, 1.2-1.5 m/second) and that the joint affected by OA also affects walking velocity (p < 0.0001). The cohort with ankle OA (0.9 ± 0.2 m/second, 0.77-0.94 m/second) walked at a slower speed relative to the cohort with hip OA (1.1 ± 0.2 m/second, 0.96-1.1 m/second; p = 0.002). However, when comparing the cohorts with ankle and knee OA (0.9 ± 0.2 m/second, 0.77-0.94 m/second) there was no difference in walking speed (p = 0.16) and the same was true when comparing the cohorts with knee and hip OA (p = 0.14). Differences in energy recovery existed when comparing the OA cohorts with the asymptomatic cohort and when examining differences between the OA cohorts. After adjusting for walking speeds these results showed that asymptomatic individuals (65% ± 3%, 63%-67%) had greater recovery than individuals with hip OA (54% ± 10%, 50%-58%; p = 0.014) and ankle OA (47% ± 13%, 40%-52%; p = 0.002) but were not different compared with individuals with knee OA (57% ± 10%, 53%-62%; p = 0.762). When speed was accounted for, 80% of the variation in recovery not attributable to speed was explained by congruity with only 10% being explained by amplitude. CONCLUSIONS OA in the hip, knee, or ankle reduces effective exchange of potential and kinetic energy, potentially increasing the muscular work required to control movements of the center of mass. CLINICAL RELEVANCE The fatigue and limited physical activity reported in patients with lower extremity OA could be associated with increased mechanical work of the center of mass. Focused gait retraining potentially could improve walking mechanics and decrease fatigue in these patients.
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Affiliation(s)
- Robin M. Queen
- grid.438526.e0000000106944940Kevin P. Granata Biomechanics Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, VA 24061 USA
| | - Tawnee L. Sparling
- grid.438526.e0000000106944940Kevin P. Granata Biomechanics Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, VA 24061 USA ,grid.25879.310000000419368972Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Daniel Schmitt
- grid.26009.3d0000000419367961Department of Evolutionary Anthropology, Duke University, Durham, NC USA
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Grier AJ, Schmitt AC, Adams SB, Queen RM. The effect of tibiotalar alignment on coronal plane mechanics following total ankle replacement. Gait Posture 2016; 48:13-18. [PMID: 27477702 DOI: 10.1016/j.gaitpost.2016.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/06/2016] [Accepted: 04/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait mechanics following total ankle replacement (TAR) have reported improved ankle motion following surgery. However, no studies have addressed the impact of preoperative radiographic tibiotalar alignment on post-TAR gait mechanics. We therefore investigated whether preoperative tibiotalar alignment (varus, valgus, or neutral) resulted in significantly different coronal plane mechanics or ground reaction forces post-TAR. METHODS We conducted a non-randomized study of 93 consecutive end-stage ankle arthritis patients. Standard weight-bearing radiographs were obtained preoperatively to categorize patients as having neutral (±4°), varus (≥5° of varus), or valgus (≥5° of valgus) coronal plane tibiotalar alignment. All patients underwent a standard walking assessment including three-dimensional lower extremity kinetics and kinematics preoperatively, 12 and 24 months postoperatively. RESULTS A significant group by time interaction was observed for the propulsive vertical ground reaction force (vGRF), coronal plane hip range of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated an increase in the peak knee adduction angle and knee adduction angle at heel strike when compared to the other groups. Coronal plane ankle ROM, knee and hip angles at heel strike, and the peak hip angle exhibited significant increases across time. Peak ankle inversion moment, peak knee abduction moment and the weight acceptance vGRF also exhibited significant increases across time. Neutral ankle alignment was achieved for all patients by 2 years following TAR. CONCLUSIONS Restoration of neutral ankle alignment at the time of TAR in patients with preoperative varus or valgus tibiotalar alignment resulted in biomechanics similar to those of patients with neutral preoperative tibiotalar alignment by 24-month follow-up.
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Affiliation(s)
- A Jordan Grier
- Michael W. Krzyzewski Human Performance Lab, Duke University, United States; Department of Orthopaedic Surgery, Duke University, United States.
| | - Abigail C Schmitt
- Michael W. Krzyzewski Human Performance Lab, Duke University, United States; Department of Orthopaedic Surgery, Duke University, United States.
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, United States.
| | - Robin M Queen
- Kevin Granata Biomechanics Lab, Virginia Tech, United States; Department of Biomedical Engineering and Mechanics, Virginia Tech, United States.
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Wiewiorski M, Hoechel S, Anderson AE, Nowakowski AM, DeOrio JK, Easley ME, Nunley JA, Valderrabano V, Barg A. Computed Tomographic Evaluation of Joint Geometry in Patients With End-Stage Ankle Osteoarthritis. Foot Ankle Int 2016; 37:644-51. [PMID: 26843547 DOI: 10.1177/1071100716629777] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deformation of the talus and the distal tibia can be frequently observed during ankle joint osteoarthritis (OA). The aim of this study was to objectify these morphologic changes. We hypothesized that a flattening of the talus and a broadening of the distal tibia surface occurs in end-stage OA of the ankle joint. METHODS Twenty-seven computed tomography (CT) ankle joint examinations of unilateral ankle OA were matched by sex and age with 27 CT examinations of healthy ankle joints. Three-dimensional reformatting and measurements were performed with geometry analysis software. The following parameters were assessed: sagittal radius of the talus, talus height, and mediolateral and anteroposterior width of the distal tibial joint surface. RESULTS Medial, midsagittal, and lateral sagittal arc radii of osteoarthritic tali were significantly larger compared to tali of controls. There was a statistically significant difference in the height of the osteoarthritic talar dome in the medial and in the lateral frontal segment and in the medial central segment compared to tali of controls. The anteroposterior width and the sagittal curvature of the distal tibia was significantly larger in OA ankles than in the control group. The mediolateral measurements were comparable across both groups. CONCLUSION Flattening of the talus appears to be more pronounced in the frontal aspect of the talus. The distal tibia broadens anteroposteriorly. These findings may contribute to better understanding of ankle OA development. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Martin Wiewiorski
- Department of Orthopaedic and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Andrew E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Andrej M Nowakowski
- Department of Orthopaedics and Trauma Surgery, University Hospital of Basel, Basel, Switzerland
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Victor Valderrabano
- Orthopaedic and Trauma Department, Schmerzklinik Basel, Genolier Swiss Private Clinic Group GSMN, Basel, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Abstract
This paper provides an introduction to the biomechanics of the ankle, introducing the bony anatomy involved in motion of the foot and ankle. The complexity of the ankle anatomy has a significant influence on the biomechanical performance of the joint, and this paper discusses the motions of the ankle joint complex, and the joints at which it is proposed they occur. It provides insight into the ligaments that are critical to the stability and function of the ankle joint. It describes the movements involved in a normal gait cycle, and also highlights how these may change as a result of surgical intervention such as total joint replacement or fusion.
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Affiliation(s)
- Claire L Brockett
- University Academic Fellow, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK. Conflicts of interest: none declared
| | - Graham J Chapman
- University Academic Fellow, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK. Conflicts of interest: none declared
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45
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Abstract
UNLABELLED Gutter pain and impingement are recognized entities following total ankle arthroplasty (TAA). However, little concrete information is available in the existing literature regarding the etiology, potentiating factors, treatment and prevention of gutter disease. This comprehensive monograph discusses this problem in expansive detail and provides insight to surgeons who perform TAA, such that these complications can be minimized in the future. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- John M Schuberth
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
| | - David A Wood
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
| | - Jeffrey C Christensen
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
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Barg A, Amendola RL, Henninger HB, Kapron AL, Saltzman CL, Anderson AE. Influence of Ankle Position and Radiographic Projection Angle on Measurement of Supramalleolar Alignment on the Anteroposterior and Hindfoot Alignment Views. Foot Ankle Int 2015; 36:1352-61. [PMID: 26116431 DOI: 10.1177/1071100715591091] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Using digitally reconstructed radiographs (DRRs), we determined how changes in the x-ray beam projection angle from the horizon, tibiotalar joint angle, and axial rotation of the foot influenced measurements of the medial distal tibial angle (MDTA) on the anteroposterior (AP) and hindfoot alignment views (HAV). METHODS Seven cadaver foot-ankle specimens were scanned by computed tomography (CT) at fixed tibiotalar joint positions, ranging from 15 degrees of dorsiflexion to 25 degrees of plantarflexion. DRRs were created from each CT scan to simulate alterations in the horizontal projection angle (0 to 25 degrees) and foot axial rotation (-30 to 30 degrees). The MDTA was measured on each DRR and compared with that quantified on the baseline HAV and AP view. RESULTS Altering the horizontal projection angle by ≥5 degrees and >10 degrees significantly altered the MDTA for the AP view and the HAV, respectively. Shifting dorsiflexion and plantarflexion caused minor changes in the MDTA that were only statistically significant for the HAV. Axial rotation significantly changed the MDTA on both views, but deviations were more pronounced for the HAV. CONCLUSIONS Compared with the HAV, the MDTA on the AP view was less sensitive to changes in foot-ankle position. However, increasing the tilt of the x-ray beam from the horizon altered the MDTA on the AP view substantially. CLINICAL RELEVANCE To avoid misinterpretation of the MDTA, we recommend using the AP view to quantify supramalleolar alignment as it is less sensitive to changes in positioning of the foot-ankle. When acquiring an AP film, the x-ray beam should be directed along the horizon to ensure consistent assessment of the MDTA across patients.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Richard L Amendola
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Ashley L Kapron
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA Department of Bioengineering, University of Utah, Salt Lake City, UT, USA Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
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47
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Abstract
This study tested the hypothesis that the presence of isolated ankle (A-OA; N=30), knee (K-OA; N=20), or hip (H-OA; N=30) osteoarthritis (OA) compared to asymptomatic controls (N=15) would lead to mechanical changes in the affected joint but also in all other lower limb joints and gait overall. Stride length, stance and swing times, as well as joint angles and moments at the hip, knee, and ankle were derived from 3-D kinematic and kinetic data collected from seven self-selected speed walking trial. Values were compared across groups using a 1×4 ANCOVA, covarying for walking speed. With walking speed controlled, the results indicated a reduction in hip and knee extension and ankle plantar flexion in accordance with the joint affected. In addition, OA in one joint had strong effects on other joints. In both H-OA and K-OA groups the hip never passed into extension, and A-OA subjects significantly changed hip kinematics to compensate for lack of plantar flexion. Finally, OA in any joint led to lower peak vertical forces as well as extension and plantar flexion moments compared to controls. The presence of end-stage OA at various lower extremity joints results in compensatory gait mechanics that cause movement alterations throughout the lower extremity. This work reinforces our understanding of the complex interaction of joints of the lower limb and the importance of focusing on the mechanics of the entire lower limb when considering gait disability and potential interventions in patients with isolated OA.
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Affiliation(s)
- Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, DUMC 2914, Durham, NC 27710, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Robin M Queen
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Michael W. Krzyzewski Human Performance Lab, Duke University Medical Center DUMC 102916, Durham, NC 27710, USA
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48
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Nüesch C, Huber C, Paul J, Henninger HB, Pagenstert G, Valderrabano V, Barg A. Mid- to Long-term Clinical Outcome and Gait Biomechanics After Realignment Surgery in Asymmetric Ankle Osteoarthritis. Foot Ankle Int 2015; 36:908-18. [PMID: 25795650 DOI: 10.1177/1071100715577371] [Citation(s) in RCA: 24] [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 Joint-preserving, realignment surgical procedures have gained increasing popularity as treatment of asymmetric early- and mid-stage ankle osteoarthritis. The aim of the present study was to quantify bilateral gait biomechanics in patients who underwent ankle realignment surgery by supramalleolar osteotomies. METHODS Eight patients, a minimum of 7 years after realignment surgery, and 8 healthy controls were included in this study. Three-dimensional instrumented gait analysis was used to assess spatiotemporal parameters, bilateral joint angles, and moments. Furthermore, a clinical evaluation on pain, ankle function, and quality of life was performed. RESULTS Compared with the healthy controls, the patients walked more slowly, had a smaller sagittal hindfoot range of motion on their affected leg, and had a lower peak ankle dorsiflexion moment (P < .05). There were no significant differences compared with controls for the ranges of motion in the foot segments of the nonaffected foot and for the knee and hip joint ranges of motion and peak moments of both legs. Additionally, patients and controls did not differ in the quality of life score. However, in the pain subscore, the patients reported significantly more pain than the healthy persons. CONCLUSION Despite different gait biomechanics of the affected foot after ankle realignment surgery, the quality of life for patients was comparable to that of healthy controls. Therefore, supramalleolar osteotomies should be considered as a promising treatment option in patients with asymmetric non-end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Corina Nüesch
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - Cora Huber
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Hannover, Germany Center of Biomechanics and Calorimetry, University of Basel, Basel, Switzerland
| | - Jochen Paul
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - Heath B Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Geert Pagenstert
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | | | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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49
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Chao J, Choi JH, Grear BJ, Tenenbaum S, Bariteau JT, Brodsky JW. Early radiographic and clinical results of Salto total ankle arthroplasty as a fixed-bearing device. Foot Ankle Surg 2015; 21:91-6. [PMID: 25937407 DOI: 10.1016/j.fas.2014.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 07/23/2014] [Accepted: 09/27/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total ankle replacement has increased in popularity in the management of severe tibiotalar arthritis. Most previous clinical reports focused on mobile-bearing designs. This study evaluates early radiographic and clinical results of the Salto fixed bearing design. METHODS Twenty-three Salto fixed-bearing implants were prospectively studied. Records were reviewed for clinical outcome scores (VAS, AOFAS, SF36), subsequent surgeries, complications, radiographic data and implant survivorship. Average follow-up was 36 months. RESULTS Statistically significant improvements in VAS, AOFAS ankle/hindfoot scores, and SF36 scores were shown at an average of 3 years postoperatively. At 3 years followup, survivorship of the implant was 82.6% with any reoperation as the endpoint and 95.6% for revision or removal of components. Seven patients had radiolucencies around the implant, one of which required revision to arthrodesis. CONCLUSION The fixed-bearing Salto ankle replacement has comparable early radiographic and clinical results to reports of the mobile-bearing Salto of comparable followup. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- John Chao
- Peachtree Orthopaedic Clinic, Atlanta, GA, USA.
| | - Jae Hyuck Choi
- Foot and Ankle Orthopedic Department, Veterans National Hospital Daegu, Daegu, Republic of Korea.
| | - Benjamin J Grear
- Campbell Clinic, 1400 S. Germantown Rd, Germantown, TN 38138, USA.
| | - Shay Tenenbaum
- Baylor University Medical Center, Dallas, TX, USA; Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - James W Brodsky
- Baylor University Medical Center, Human Motion and Performance Laboratory, 411 N. Washington Avenue, Ste. 2100, Dallas, TX 75246, USA.
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50
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McHenry BD, Exten EL, Long J, Law B, Marks RM, Harris G. Sagittal subtalar and talocrural joint assessment with weight-bearing fluoroscopy during barefoot ambulation. Foot Ankle Int 2015; 36:430-5. [PMID: 25380773 DOI: 10.1177/1071100714559540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Identifying talar position during ambulation has proved difficult as the talus lacks palpable landmarks for skin marker placement and more invasive methodologies such as bone pins are not practical for most clinical subjects. A fluoroscopic motion system was used to track the talus and calcaneus, allowing kinematic analysis of the talocrural and subtalar joints. METHODS Thirteen male subjects (mean age 22.9 ± 3.0 years) previously screened for normal gait were tested. A fluoroscopy unit was used to collect images at 120 fps during stance. Sagittal motion of the talocrural and subtalar joints were analyzed. RESULTS The intersubject mean and standard deviation values for all 58 trials of 13 subjects are reported. Maximum talocrural joint plantarflexion of 11.2 degrees (4.3 degrees of standard deviation) occurred at 11% stance and maximum dorsiflexion of -6.9 degrees (5.6 degrees of standard deviation) occurred at 85%. Maximum subtalar joint plantarflexion of 4.8 degrees (1.0 degrees of standard deviation) occurred at 96% stance and maximum dorsiflexion of -3.6 degrees (2.3 degrees of standard deviation) occurred at 30%. Talocrural and subtalar range of motion values during stance were 18.1 and 8.4 degrees, respectively. CONCLUSION Existing fluoroscopic technology was capable of defining sagittal plane talocrural and subtalar motion during gait. These kinematic results compare favorably with more invasive techniques. This type of assessment could support more routine analysis of in vivo bony motion during gait. CLINICAL RELEVANCE Fluoroscopic technology offers improved sagittal plane motion evaluation during weight-bearing with potential application in patients with end-stage ankle arthritis, postoperative ankle replacements and fusions, and orthotics and braces.
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Affiliation(s)
| | | | - Jason Long
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brian Law
- Medical College of Wisconsin, Milwaukee, WI, USA
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