scholarly journals Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Guilherme Saito ◽  
Daniel Sturnick ◽  
Jonathan Deland ◽  
Scott Ellis ◽  
Constantine Demetracopoulos
Keyword(s):  
Ankle Joint ◽  
Tibial Component ◽  
Joint Kinematics ◽  
Transverse Plane ◽  
Total Ankle Arthroplasty ◽  
Component Position ◽  
Ankle Arthroplasty ◽  
Ankle Kinematics ◽  
Joint Contact

Category: Ankle Arthritis Introduction/Purpose: Correct positioning of total ankle arthroplasty (TAA) implants has been associated with superior clinical outcomes. Furthermore, biomechanical studies have demonstrated that poor alignment of the components may lead to early component wear, compromising the longevity of the prosthesis. Malpositioning of TAA implants affects ligament engagement patterns and joint contact mechanics, possibly leading to altered joint kinematics. However, the correlation between implant position and ankle joint motion is still unclear. The objective of this study was to assess the effect of tibial component position on ankle kinematics following TAA during simulated gait. Methods: Eight mid-tibia cadaveric specimens were utilized in this IRB approved study. The stance phase of gait was simulated both pre- and post-TAA in each specimen using a six-degree of freedom robotic platform. Ground reaction forces and tibial kinematic from in vivo data were replicated while physiologic tendon force profiles were applied to each extrinsic ankle tendons by linear actuators instrumented. Ankle kinematics was measured from reflective markers attached to bones via surgical pins. TAAs were completed using a common fixed-bearing total ankle system following the manufacturer recommended protocol (Salto Talaris, Integra LifeSciences). Using reconstructed CT data, 3D tibial component position relative to a standard ankle joint reference was characterized (Figure 1A). The effect of tibial component position on absolute differences in ankle kinematics (pre – post TAA) was assessed using linear regression with a level of significance set to p = 0.05. Results: Differences in ankle joint kinematics were only identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared to the native condition (Figure 1B). The medial position of TAA tibial components was found to be positively associated with increased internal talar rotation (Figure 1C; β = 1.861 degrees/mm, R2 = 0.72, p = 0.008). No other measurements of tibial component position (anterior-posterior/inferior-superior position, sagittal/frontal/transverse plane angle) were found to be significantly associated with altered ankle kinematics following TAA (All β < 0.1 and p > 0.05). Conclusion: This study suggests that medial positioning of the tibial implant affects ankle kinematics. During operative procedures the tibial component is usually positioned in order to preserve bone stock of the medial and lateral malleolus. However, little attention is given to the position of the implant in relation to the center of the tibial axis. This finding could have clinical implications for techniques implemented during surgical procedures and for the development of new instrumentation systems.

Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait

2019 ◽  
Vol 40 (8) ◽  
pp. 873-879 ◽  
Author(s):  
Guilherme H. Saito ◽  
Daniel R. Sturnick ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Constantine A. Demetracopoulos
Keyword(s):  
Tibial Component ◽  
Lateral Position ◽  
Plane Motion ◽  
Joint Kinematics ◽  
Transverse Plane ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Component Position ◽  
Ankle Arthroplasty ◽  
Ankle Kinematics

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.

scholarly journals TL 18049 - Influence of tibial component position on altered kinematics following total ankle arthroplasty during simulated gait

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 63S
Author(s):  
Guilherme Honda Saito ◽  
Daniel Sturnick ◽  
Jonathan Deland ◽  
Scott Ellis
Keyword(s):  
Ankle Joint ◽  
Tibial Component ◽  
Degrees Of Freedom ◽  
Lateral Position ◽  
Total Ankle Arthroplasty ◽  
Component Position ◽  
Ankle Arthroplasty ◽  
Ankle Motion ◽  
Ankle Kinematics ◽  
Ct Data

Introduction: Correct positioning of total ankle arthroplasty (TAA) implants has been associated with superior clinical outcomes. However, the correlation between implant position and ankle motion is unclear. The objective of this study was to assess the effect of tibial component position on ankle kinematics during simulated gait. Methods: The stance phase of gait was simulated pre and post-TAA with 8 mid-tibia cadaveric specimens using a six-degrees-of-freedom robotic platform. Ankle kinematics were measured based on reflective markers. A fixed-bearing total ankle system (Salto Talaris, Integra LifeSciences) was used. Using reconstructed CT data, the 3D tibial component position relative to a standard ankle joint reference was characterized (Fig 1A). The effect of the tibial component position on absolute differences in ankle kinematics (pre/post TAA) was assessed using linear regression with a level of significance set to p = 0.05. Results: Differences in ankle joint kinematics were only identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared with the native condition (Fig 1B). The medial position of TAA tibial components was positively associated with increased internal talar rotation (Fig 1C; β = 1.861 degrees/mm, R2 = 0.72, p = 0.008). Conclusion: This study suggests that a medial-lateral position of the tibial implant affects ankle kinematics. During operative procedures, the tibial component is usually positioned to preserve the bone stock of the medial and lateral malleolus. However, little attention is given to the position of the implant in relation to the center of the tibial axis. This finding could have clinical implications for techniques.

scholarly journals Kinematics of a Pyrocarbon Ankle Spacer for the Treatment of Arthritic Disease

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0041
Author(s):  
Daniel R. Sturnick ◽  
Charles L. Saltzman ◽  
Albert H. Burstein ◽  
Matthew A. Hamilton ◽  
Jonathan T. Deland
Keyword(s):  
Ankle Joint ◽  
Structural Integrity ◽  
Articular Surface ◽  
Treatment Options ◽  
Joint Kinematics ◽  
Ankle Arthritis ◽  
Lower Limb Injury ◽  
Ankle Kinematics ◽  
Significant Difference

Category: Ankle, Ankle Arthritis Introduction/Purpose: Treatment options for ankle arthritis in younger patients are currently limited. Since the longevity of modern total ankle replacements is not sufficient for this patient population, ankle arthrodesis is typically utilized when joint preserving treatment is not a viable option. A new procedure using a pyrocarbon ankle spacer has been developed as a potential alternative, allowing for talar articular resurfacing for pain relief with minimal bone resection. The objective of this study was to assess whether this pyrocarbon ankle spacer could provide normal ankle kinematics as the native ankle joint using cadaveric gait simulation. Methods: Five mid-tibia cadaveric specimens without deformity and no history of lower limb injury or surgery were utilized. The stance phase of gait was simulated for each specimen using a six degree-of-freedom robotic device. A force plate was moved relative to stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Magnitudes of load were scaled to that of 25% bodyweight. Ankle kinematics were measured from reflective markers attached to the tibia and talus via surgical pins. The pyrocarbon ankle spacer (Exactech, Gainesville, FL, USA) was implanted in a nest formed 3-4 mm in depth on the talar articular surface using a custom burring technique (Figure 1B). Ankle spacer kinematics were compared to 95% confidence intervals of native, intact ankle joint kinematics to assess agreement. Results: Outcomes revealed no significant difference in ankle joint kinematics between the native, intact condition and post- pyrocarbon spacer implantation (Figure 1C). This result was consistent for the sagittal, coronal and axial planes of motion. Conclusion: The results of this study demonstrate that a pyrocarbon spacer permits normal ankle kinematics. Further, the device was observed to be stable in the joint throughout simulations. While the testing was performed at 25% bodyweight for analyses on all specimens, load magnitudes were also increased up to 75% on a subset of specimens and the structural integrity of the device remained pristine. With these findings, we concluded that the pyrocarbon spacer device offers promising potential as a treatment option for ankle arthritis.

Kinematics of a Total Arthroplasty of the Ankle: Comparison to Normal Ankle Motion

2000 ◽  
Vol 21 (4) ◽  
pp. 278-284 ◽  
Author(s):  
James D. Michelson ◽  
Guy R. Schmidt ◽  
Mark S. Mizel
Keyword(s):  
Stress Transfer ◽  
Total Ankle Arthroplasty ◽  
Subtle Change ◽  
Ankle Arthroplasty ◽  
Ankle Motion ◽  
3 Dimensional ◽  
Total Arthroplasty ◽  
Ankle Kinematics ◽  
Joint Contact ◽  
The Difference

Although the concept of a total ankle arthroplasty has been advanced as a method for treating severe ankle arthritis, the clinical experience with all of the models developed has been discouraging. Both the constrained designs, which maximize joint contact area by restricting the available motion, and the unconstrained designs, which allow more normal motion at the expense of higher contact stresses, uniformly result in implant loosening, pain, and clinical failure in 2 to 7 years. This has led to the recommendation against the use of a total ankle arthroplasty except in very low-demand patients. Failure of ankle implants can be ascribed to either anatomic considerations (e.g. -the talus is too small to accommodate the stress transfers of a prosthesis), or mechanical etiologies. Abnormal 3-dimensional motion of the ankle following arthroplasty would fall into the latter category. This study examined the motion that occurs after implantation of an unconstrained-type total ankle arthroplasty. Using previously validated methodology, axially loaded ankle specimens were cycled through an arc of plantarflex/dorsiflexion while measuring the resulting coupled internal/external and varus/valgus rotations. The average coupled motions in prosthetic ankles were not significantly different than their intact controls. There was, however, a significantly increased amount of hysteresis (defined as the difference between the upper and lower pathways of coupled motion at any given sagittal position) that occurred as the ankle was dorsiflexed and plantar flexed. The increased hysteresis was seen in both the axial and coronal planes. This indicates that there was a greater permitted envelop of motion in the prosthetic ankles compared to normal ankles. It is hypothesized that this subtle change in ankle kinematics caused by the arthroplasty leads to abnormal stress transfer at the prosthesis-bone interface, thereby promoting early implant failure.

Musculoskeletal modeling of total ankle arthroplasty using force-dependent kinematics for predicting in vivo joint mechanics

2019 ◽  
Vol 234 (2) ◽  
pp. 210-222 ◽  
Author(s):  
Yanwei Zhang ◽  
Zhenxian Chen ◽  
Hongmou Zhao ◽  
Xiaojun Liang ◽  
Cheng Sun ◽  
...  
Keyword(s):  
Body Weight ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Contact Forces ◽  
Total Ankle Arthroplasty ◽  
Musculoskeletal Modeling ◽  
Patient Specific ◽  
Joint Mechanics ◽  
Ankle Arthroplasty

In vivo load and motion in the ankle joint play a key role in the understanding of the failure mechanism and function outcomes of total ankle arthroplasty. However, a thorough understanding of the biomechanics of the ankle joint in daily activities is lacking. The objective of this study was to develop a novel lower extremity musculoskeletal multibody dynamics model with total ankle arthroplasty considering the 6 degrees of freedom of the ankle joint motions and the deformable contact mechanics of the implant, based on force-dependent kinematics method. A patient who underwent total ankle arthroplasty surgery was considered. The walking gait data of the patient was measured in a gait laboratory and used as the input for the patient-specific musculoskeletal modeling. The predictions from the musculoskeletal model of total ankle arthroplasty included dorsiflexion–plantar flexion, inversion–eversion, internal–external rotation, anterior–posterior translation, inferior–superior translation, and medial–lateral translation of the tibiotalar joint, the ankle contact forces, the muscle activations, and the ligament forces. The magnitudes and tendencies of the predicted results were all within reasonable ranges, as compared with the data available in the literature. The predicted peak total ankle contact force was 6.55 body weight. In addition, the peak contact forces of the lateral and medial compartments were 4.22 body weight and 2.59 body weight, respectively. This study provides a potential new platform for the design of a better ankle prosthesis, the improvement of the operation techniques of the clinicians, and the accelerated postoperative recovery of the patients.

In vivo kinematics of fixed-bearing total ankle arthroplasty

2020 ◽  
Vol 26 (4) ◽  
pp. 371-377 ◽  
Author(s):  
Gloria Casaroli ◽  
Tomaso Villa ◽  
Alberto Bianchi ◽  
Eleonora Caboni ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Total Ankle Arthroplasty ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
In Vivo Kinematics

scholarly journals Axial Rotational Alignment of Mobile-Bearing Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Beat Hintermann ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Alexej Barg ◽  
Roxa Ruiz
Keyword(s):  
Tibial Component ◽  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Axial Position ◽  
Anterior Surface ◽  
Ankle Arthroplasty ◽  
Medial Border ◽  
Wide Range ◽  
Angle Of Rotation

Category: Ankle Arthritis Introduction/Purpose: In total ankle arthroplasty (TAA), component malpositioning is a major cause of implant failure, possibly due to the altered force patterns caused by the malpositioning which are then transmitted to the bone-implant interface or neighboring joints during physiological loading. Mobile-bearing TAA with their second interface, may allow the talus to adapt its position based upon the individual anatomy. However, no data exist on the change in component positioning after implantation. It is unclear whether it is the result of initial positioning during implantation or secondary adjustments such as possible soft tissue adaptions. We aimed to determine the relative axial rotation between the talar and tibial components at the end of surgery and after a minimum of 3 years follow-up. Methods: The relative rotation between the tibial and talar components was measured in two groups. First, intraoperatively before wound closure, in a consecutive series of 58 patients (60 ankles; age 61.8 [31 to 86] years; females 25, males, 35) who underwent TAA between February and November 2018. A K-wire inserted along the medial border of the tibial component and a rectangular marker positioned at the anterior surface of PE insert were used to determine the angle of rotation. Second, in 48 patients (48 ankles; age 60.2 [31 - 82] years; females, 24; males, 24) out of 1411 patients who underwent TAA between January 2003 and December 2015, and in whom a weight-bearing CT scan was taken for evaluation at 6.3 (range, 3.0 -16.3) years. The medial border of the tibial component and a perpendicular line to the anterior surface of the PE insert were used to determine the angle of rotation. Results: The angle of rotation, thus the relative position of the talar component compared to the tibial component, did not differ between the two groups (p = 0.2). While the talus was internally rotated by 1.7 (range, -14.0 - 14.0) degrees at the end of surgery, it was internally rotated by 1.5 (range, -13.0 – 19.5) degrees after a minimum follow-up of 3 years (Figure 1). Conclusion: Although there was no significant difference in average axial position measured intraoperatively compared to a 3- years follow-up, there was a wide range of rotational measurements. The possibility of the talar component to find its position as given by individual anatomy may be crucial in TAA to avoid non-physiological joint loads and shear forces which may otherwise result in increased PE wear. Due to the wide range of measurements, our data suggests that axial talar rotation cannot be predicted preoperatively or intraoperatively by surgical techniques that reference the transtibial axis, tibial tuberosity and transmalleolar axis as guidance for tibial component positioning.

Radiographic Outcomes of Mobile-Bearing Total Ankle Arthroplasty for Patients With Rheumatoid Arthritis

2019 ◽  
Vol 40 (9) ◽  
pp. 1037-1042
Author(s):  
Koichiro Yano ◽  
Katsunori Ikari ◽  
Ken Okazaki
Keyword(s):  
Rheumatoid Arthritis ◽  
Tibial Component ◽  
Patient Reported Outcomes ◽  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported

Background: Ankle disorders in patients with rheumatoid arthritis (RA) reduce their quality of life and activities of daily living. The aim of this study was to evaluate the midterm clinical and radiographic outcomes of TAA in patients with RA. Methods: This retrospective study included patients with a minimum follow-up of 2 years. A total of 37 RA patients (39 ankles) were enrolled in this study from August 2006 to March 2016. All the patients had undergone primary cemented mobile-bearing total ankle arthroplasty (TAA). Nine ankles received arthrodesis of the subtalar joint simultaneously. Patient-reported outcomes were measured preoperatively and at the latest follow-up by Self-Administered Foot-Evaluation Questionnaire (SAFE-Q). Radiographs of the ankle were analyzed preoperatively and at all follow-up visits to measure the periprosthetic radiolucent line, migration of the tibial component, and the subsidence of the talar component. Intraoperative and postoperative complications were recorded. The average duration of follow-up for the entire cohort was 5.0 ± 2.0 years (range 2.1-10.1 years). Results: All subscales of the SAFE-Q had improved significantly at the latest follow-up. No significant difference was found between the range of motion of the ankle before and after the surgery. Radiolucent lines were observed in 28 (73.7%) ankles. Migration of the tibial component and subsidence of the talar component were found in 8 (21.1%) and 11 (28.9%) ankles, respectively. Intraoperative malleolus fractures occurred in 3 (7.7%) ankles and delayed wound healing in 10 (25.6%) ankles. Four ankles were removed because of deep infection or noninfective loosening, resulting in an implant survival rate of 88.4% (95% CI, 0.76-1.0) at 10 years. Conclusion: The midterm patient-reported outcomes and implant retention rate after cemented mobile-bearing TAA for RA patients were satisfactory. However, a low radiographic implant success rate was observed. Level of Evidence: Level IV, retrospective case series.

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