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 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.

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.

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.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

scholarly journals Changes in the Plantarflexion Moment Arm of the Achilles Tendon Following Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
Francesca E. Wade ◽  
Gregory Lewis ◽  
Andrea H. Horne ◽  
Lauren Hickox ◽  
Michael C. Aynardi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Ankle Joint ◽  
Sagittal Plane ◽  
Total Ankle Arthroplasty ◽  
Moment Arm ◽  
Talar Dome ◽  
Ankle Arthroplasty ◽  
Joint Structure ◽  
Joint Axis ◽  
Mean Differences

Category: Ankle; Ankle Arthritis Introduction/Purpose: Deficits in ankle joint kinetics following total ankle arthroplasty (TAA) may be attributed to a reduction in the force-generating capacity of ankle joint muscles, but it is also important to consider the alterations to joint structure that may accompany this procedure. One key parameter indicative of joint structure with the potential to be influenced by TAA is the plantarflexion moment arm of the Achilles tendon (ATma). ATma is an indicator of the potential for the tendon force to produce plantarflexion moment that is determined by the three-dimensional line of action of the tendon relative to the ankle joint axis. The purpose of this study was to assess pre-to-post TAA changes in ATma; we hypothesized that pre- and post-TAA moment arms would not be different. Methods: We tested 10 TAA patients (age at surgery: 62.86 +- 9.72 y; height: 1.72 +- 0.08 m; body mass: 97.81 +- 20.89 kg) at pre-operative (˜ 1 mo pre) and post-operative (˜6 mo post) visits. All procedures involving testing of human subjects were approved by the Penn State Hershey Medical Center Institutional Review Board. ATma were measured using a method that combined ultrasound imaging of the tendon with 3D motion tracking of both the ultrasound probe and the ankle joint. The tendon and joint axis were located during trials in which the patients were seated with the knee extended while the ankle joint was voluntarily rotated in the sagittal plane. We also examined sagittal-plane weightbearing radiographs (pre- and post-op) to determine the AP distance from the center of the talar dome to the posterior margin of the calcaneus. Pre- and post-op ATma were compared using a paired t-test and regression. Results: No significant mean differences were found between post-op ATma and pre-op ATma (p = 0.360). Despite this, some patients were found to have large differences between pre- and postoperative ATma. For example, participants 1, 3, and 8 exhibited changes of -54.22%, +64.14% and +123.98% (pre-to-post) respectively (Figure 1). A moderate correlation between pre- and post-op ATma was found (r2 = 0.461, p = 0.031), indicating that only 46.1% of the variance in post-op ATma was explained by pre-op ATma (Figure 1). The normalized AP distance measured from the radiographs did not significantly change on average pre- to post-TAA (p = 0.561), and we found the change in this distance to correlate with the change in ATma (r2 = 0.370, p = 0.062). Conclusion: This is the first investigation of whether TAA alters ATma. Our results supported our hypothesis that pre-operative ATma predicts post-operative ATma. However, our hypothesis is supported only when the mean differences are considered, as there were sizeable differences for individuals. Despite a non-significant average change in ATma following TAA, at the individual level substantial changes in ATma were observed in seven of the 10 patients. Change in ATma was only partly explained by change in the AP position of the talar dome. Change in ATma has potential consequences for function in terms of ankle plantarflexor strength and walking velocity.

Early to Mid-Term Results of Fixed-Bearing Total Ankle Arthroplasty with a Modular Intramedullary Tibial Component

2014 ◽  
Vol 96 (23) ◽  
pp. 1983-1989 ◽  
Author(s):  
Samuel B. Adams ◽  
Constantine A. Demetracopoulos ◽  
Robin M. Queen ◽  
Mark E. Easley ◽  
James K. DeOrio ◽  
...  
Keyword(s):  
Tibial Component ◽  
Total Ankle Arthroplasty ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Mid Term Results
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