A three-year prospective comparative gait study between patients with ankle arthrodesis and arthroplasty. (May 2018)

• Record Type: Journal Article
• Authors: Segal, Ava D.; Cyr, Krista M.; Stender, Christina J.; Whittaker, Eric C.; Hahn, Michael E.; Orendurff, Michael S.; Ledoux, William R.; Sangeorzan, Bruce J.
• Is Part Of: Clinical biomechanics. Volume 54(2018)
• Page Start: 42
• Page End: 53
• Publication Date: 2018-05
• Subjects: A1m peak ankle plantar flexion moment (terminal stance) -- A1a peak ankle power absorption -- A2a peak ankle power generation -- Abd abduction -- Add adduction -- Abs absorption -- deg Degrees -- Dorsi dorsiflexion -- Ext extension -- Flex flexion -- Gen generation -- GRFZ vertical ground reaction force -- HST heel strike transient -- K1a peak knee power absorption (early stance) -- K2a peak knee power generation (mid-stance) -- K3a peak knee power absorption (early swing) -- K4a peak knee power absorption (terminal swing) -- H1a peak hip power generation (early stance) -- H2a peak hip power absorption (terminal stance) -- H3a peak hip power generation (early swing) -- K1m peak knee extension moment (early stance) -- K2m peak knee flexion moment (mid-stance) -- H1m peak hip extension moment (early stance) -- H2m peak hip flexion moment (mid-stance) -- H3m peak hip extension moment (terminal swing) -- P0 baseline (preoperative) session -- P1 first year follow-up (postoperative) session -- P2 second year follow-up (postoperative) session -- P3 third year follow-up (postoperative) session -- Plantar plantar flexion -- m/s meters/second -- min minute -- MFA musculoskeletal function assessment survey -- RoM range of motion -- s seconds -- SE standard error -- SF-36 Short Form (36 questions) survey; End-stage ankle arthritis -- Kinematics -- Kinetics -- Biomechanics -- Push-off power -- Heel strike transient; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2018.02.018
• Languages: English
• ISSNs: 0268-0033

Abstract

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. Highlights: Pain and function improved after both surgeries at the one-year follow-up session. Improvements were generally maintained across the three-year follow-up sessions. Arthrodesis patients increased loading forces at heel strike postoperatively. Small biomechanical differences between surgeries may affect longer-term outcomes. Neither surgery completely restored gait biomechanics to contralateral limb levels.