A three-year prospective comparative gait study between patients with ankle arthrodesis and arthroplasty

• Published in: Clinical biomechanics (Bristol) 2018-05, Vol.54 (NA), p.42-53
• Main 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.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Joint - physiopathology; Arthrodesis - methods; Arthroplasty, Replacement, Ankle - methods; Biomechanics; End-stage ankle arthritis; Female; Gait - physiology; Heel strike transient; Humans; Kinematics; Kinetics; Male; Middle Aged; Osteoarthritis - physiopathology; Osteoarthritis - surgery; Postoperative Period; Prospective Studies; Push-off power; Range of Motion, Articular - physiology; Treatment Outcome; Walking; Walking Speed
• ISSN: 0268-0033; 1879-1271
• DOI: 10.1016/j.clinbiomech.2018.02.018

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. 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. 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. 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. •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.