SLR - August 2018 - Derrick Roland

Ankle Arthroplasty and Ankle Arthrodesis: Gait Analysis Compared with Normal Controls

Reference: Singer S, Klejman S, Pinsker E, Houck J, Daniels T. Ankle Arthroplasty and Ankle Arthrodesis: Gait Analysis Compared with Normal Controls. J Bone and Joint Surg AM. 2013; 95 (24): e191(1–10).  

Scientific Literature Review

Reviewed By: Derrick Roland, DPM
Residency Program: Westside Regional Medical Center, Plantation FL

Podiatric Relevance: This is a head-to-head comparison study between ankle arthroplasty and arthrodesis against a control group of healthy individuals with extensive gait analysis and patient-reported outcome comparisons. As expected, ankle arthroplasty showed greater maintained sagittal plane motion of the ankle joint as compared to arthrodesis. The patient-reported outcome measures were comparable with no clear advantage to utilizing arthroplasty. The authors were unable to determine or speculate on the cause of this finding. More research is necessary to determine why arthroplasty patients did not achieve a more normalized gait, and subsequent studies could play a crucial role in talo-tibial joint implant design.  

Methods: A level II therapeutic study was performed on patients with isolated ankle arthritis. Seventeen patients underwent total ankle arthroplasty, 17 patients underwent arthrodesis and 10 control subjects were included for comparison. This study uses both patient-reported outcome measures (AOS and SF-36) and objective outcome measures. Bilateral barefoot gait data was collected using a motion capture system, and ground reaction forces were recorded using two force plates. Three-dimensional kinematics and radiographic parameters were measured and evaluated as well.

Results: Patients who underwent arthroplasty demonstrated greater postoperative total sagittal plane motion in degrees (18.1 vs. 13.7), dorsiflexion (11.9 vs. 6.8; p < 0.05), and range of tibial tilt (23.1 vs. 19.1). Plantar flexion motion was not equivalent to normal in either group. Ankle moments and power in both treatment groups remained significantly lower compared with the control group (p < 0.05 between each group). Gait patterns in both treatment groups were not completely normalized. Improvements in patient-reported AOS and SF-36 scores were similar for both treatment groups.

Conclusion: The results of this investigation demonstrate that neither ankle arthroplasty nor arthrodesis replicated normal ankle function based on gait analysis. In addition, between both operative groups, there were no significant difference in ankle power, moments or temporal gait parameters. Patient-reported outcome scores were similar for both groups. Gait mechanics were more normalized following ankle arthroplasty with maintained sagittal joint motion and ankle kinematics. Further investigation is required to determine why patients who have undergone total ankle arthroplasty do not use the plantar flexion motion in the terminal-stance phase and to explain the limited increase in power generation at toe-off after arthroplasty. 

Educational Opportunities