Bilateral differences in gait mechanics following total ankle replacement: A two year longitudinal study (original) (raw)
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PM&R, 2014
Objective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion: The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA.
Gait & Posture, 2009
The goal was to evaluate the effect of total ankle replacement (TAR) on gait in terms of mechanical and energetic variables. Methods: An observational, prospective study was undertaken in 20 patients before and approximately 7 months after unilateral mobile-bearing TAR. The clinical-functional level was assessed according to the American Orthopaedic Foot and Ankle Society 'AOFAS'. An instrumented motion analysis was used to assess spatiotemporal parameters, ankle kinematics, mechanical work, and electromyographic activity. Energy expenditure was analyzed using an ergospirometer. Results: AOFAS score improved 1.5 times. The speed was also significantly improved. In order to limit the influence of speed and to highlight the effect of the surgery, all variables were normalized by z-score to isolate the effect of TAR. With normalized z-score, spatiotemporal parameters and ankle amplitude instance were significantly improved. The vertical center of mass displacement was significantly improved, showing a less flat-walking pattern, and decreasing energy expenditure. Our results show that TAR has a beneficial effect on locomotor function. Conclusions: Many studies have shown that improved clinical outcomes can be expected with the new generation of prostheses and this was as confirmed by our study. However, no previous study has investigated the effect of TAR on the functional limitations of gait as represented by mechanical and energetic variables.
Journal of Orthopaedic Research, 2013
Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.
Clinical Orthopaedics and Related Research®, 2017
Background Total ankle arthroplasty (TAA) is an alternative to arthrodesis, but no randomized trial has examined whether a fixed bearing or mobile bearing implant provides improved gait mechanics. Questions/purposes We wished to determine if fixed-or mobile-bearing TAA results in a larger improvement in pain scores and gait mechanics from before surgery to 1 year after surgery, and to quantify differences in outcomes using statistical analysis and report the standardized effect sizes for such comparisons. Methods Patients with end-stage ankle arthritis who were scheduled for TAA between November 2011 and June 2013 (n = 40; 16 men, 24 women; average age, 63 years; age range, 35-81 years) were prospectively recruited for this study from a single foot and ankle orthopaedic clinic. During this period, 185 patients underwent TAA, with 144 being eligible to participate in this study. Patients were eligible to participate if they were able to meet all study inclusion criteria, which were: no previous diagnosis of rheumatoid arthritis, a contralateral TAA, bilateral ankle arthritis, previous revision TAA, an ankle fusion revision, or able to walk without the use of an assistive device, weight less than 250 pounds (114 kg), a sagittal or coronal plane deformity less than 15°, no presence of avascular necrosis of the distal tibia, no current neuropathy, age older than 35 years, no history of a talar neck fracture, or an avascular talus. Of the 144 eligible patients, 40 consented to participate in our randomized trial. These 40 patients were randomly assigned to either the fixed (n = 20) or mobile bearing implant group (n = 20). Walking speed, bilateral peak dorsiflexion angle, peak plantar flexion angle, sagittal plane ankle ROM, peak ankle inversion angle, peak plantar flexion moment, peak plantar flexion power during stance, peak weight acceptance, and propulsive vertical ground reaction force were analyzed during seven self-selected speed level walking trials for 33 participants using an eight-camera motion analysis system and four force plates. Seven patients were not included in the analysis owing to cancelled surgery (one from each Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma
Physical Therapy, 2006
Background and Purpose. Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lowerextremity reconstruction. Subjects. Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. Methods. The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. Results. The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. Discussion and Conclusion. The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions. [Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ; LEAP Study Group. Gait symmetry and walking speed analysis following lower-extremity trauma.
2010
Bu çalışmada, tek taraflı kısmi kalça artroplastili hastalarda yürüme bozuklukları, simetri ve asimetri saptandı. Hastalar ve yöntemler: Tek taraflı kısmi kalça artroplastisi yapılan 16 hastanın (9 kadın, 7 erkek; ort. yaş 61.5±16.5 yıl; dağılım 27-86 yıl) yürüyüş karakteristikleri ve ameliyattan sonra geçen süre (11.9±6.1 ay; dağılım 7-29 ay) değerlendirildi. On sağlıklı gönüllü (3 kadın, 7 erkek; ort. yaş 54.1±11.9; dağılım 35-65 yıl) kontrol grubu olarak çalışmaya dahil edildi. Kantitatif yürüyüş verileri, Vicon 370 System (Oxford Metrics, Oxford, UK) kullanılarak toplandı. Spatio-temporal (yürüme hızı, kadans, adım zamanı, adım uzunluğu, çift destek zamanı) ve kinematik (sagittal planda pelvis ve kalçanın eklem rotasyon açıları) veriler, Vicon Clinical Manager yazılımı kullanılarak değerlendirildi. Her iki gruptaki hastalarda, spatio-temporal ve kinematik yürüme simetri indeksleri hesaplandı. Bulgular: Tek taraflı kısmi kalça artroplastili hastaların spatio-temporal ve kinematik yürüme karakteristikleri kontrol grubundakinlerden farklıydı ancak simetri indeksleri açısından fark yoktu (p>0.05). Sonuç: Bu çalışmanın sonuçları, tek taraflı kısmi kalça artroplastili hastaların sağlıklı bireylerle karşılaştırıldığında çeşitli yürüme bozukluklarına sahip olduklarını, ancak yürüme simetrilerinin korunduğunu göstermiştir. Anahtar sözcükler: Femur boyun kırığı; yürüme özellikleri; kısmi kalça artroplastisi; simetri indeksi. Objectives: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. Patients and methods: Gait characteristics and time since operation (11.9±6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5±16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1±11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. Results: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). Conclusion: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.
Shortcomings of Gait Cycle Parameters in Patient Treatment
JANUARY 2014 | PODIATRY MANAGEMENT 137 T he classically described gait cycle breaks down how we should walk when moving in a forward manner but not how we function throughout daily life. Biomechanics is the study of the way we function, how we do what we do. It is based on when events happen, how long they happen, the force and direction of what is happening and the order of said events. When performing a gait analysis we make observations and collect data, then compare those value judgments to established "norms". But do those "norms" really apply to the patient in question?
Clinical Relevance of Hindfoot Alignment View in Total Ankle Replacement
Foot & Ankle International, 2010
in TAR, only coronal alignment in the region of the tibiotalar joint or above has been assessed because inframalleolar deformity is difficult to visualize radiographically. The Hindfoot Alignment View (HAV) allows visualization of the hindfoot position relative to the tibia. The purpose of this study was to evaluate the clinical relevance of this view in assessing patients with TAR. Materials and Methods: Twentyeight consecutive patients with a Hintegra-TAR with an average followup of 4.1 ± 1.5 years were followed with (1) AOFAS and SF-36 scores, (2) visual judgment of the hindfoot position, (3) HAV and AP/lateral radiographs, (4) dynamic pedobarography (Novel emed m/E, Munich, Germany). Results: The HAV position correlated well with different load parameters on heel strike (r = 0.44 to 0.62) but not with the varusvalgus load pattern of the rest of the foot. Visual judgment and TAR joint line did not correlate to radiographic hindfoot alignment or to pedobarographic load distribution. The hindfoot alignment measured by the HAV correlated significantly to the Physical Function and Role Physical of SF-36. No correlation was found to other SF36-qualities or the AOFASscore. Conclusion: Inframalleolar alignment, as assessed by the HAV, influenced the dynamic pedobarographic load pattern and clinical outcome. Visual judgment and TAR joint line were not accurate enough to estimate the hindfoot alignment or dynamic load pattern. We believe adjusting the hindfoot correctly with HAV might improve long-term outcome and survival of TAR.
Background Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s pathological gait, physician’s requirements and the rehabilitative goals, orthotists must produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance. Many studies established the functional value of common and well-known ankle foot orthoses (AFOs) by developing pathological gait. Solid AFOs (SAFOs) do not allow any ankle movements and are used for patients with spasticity. The so-called Floor Reaction AFO (FRAFO) is a ventral shell orthoses that blocks any ankle joint movement, enables the knee extension in terminal stance, but is controindicated in patients with an hyperextended knee. HAFO or classical hinged AFO are designed with elastomer spring joints without any spring effect or any dorsal stop that blocks any plantar flexion and enables a dorsiflexion with defined pivot point in the anatomical ankle joint. PLS-AFOs or posterior leaf spring AFOs, have commonly a high carbon spring effect but do neither have a pivot point, a defined or adjustable range of movement nor an adjustable alignment. Aim To perform a comparative spatio-temporal gait evaluation by using SAFO or solid AFO (Codivilla spring) and FRAFO or so-called floor reaction AFO (Toe-Off) vs an innovative dynamic hinged Ankle-Foot-Orthoses designed with an innovative ankle joint system called Neuroswing (DAFONS) on patients affected by different pathological gait patterns secondary to different central nervous system damages. Study design Comparative investigational study. Setting A rehabilitation institute for the treatment of neurological gait disorders. Population Five patients affected by different neurological gait pattern were recruited for the aim of this study in line with an informed consent and simple inclusion (cooperating patient, evidence of pathological gait pattern, bearer of a DAFONS) and exclusion (not cooperating patient, evidence of a physiological gait pattern, not bearer of a DAFONS) criteria. Methods In line with a personalized operating flow-chart, each patient underwent to a: visual gait analysis (VGA), focusing attention on orthostatic and orthodynamic trunk attitude, core stability and hip range of movement in stance and swing, knee and ankle stability and movement attitude in stance and swing, analytical and global movement attitude of the trunk-hip-lower limb unit, biomechanical movement profile of the ankle during the stance and swing phase of gait spatio-temporal BTS-G Walk sensor gait analysis, focusing attention on the average value of the Test duration (sec), Gait speed (m/sec), Gait cadence (steps/min), N° of step cycle on the left side, N° of step cycle on the right side, Stride lenght on the left and on the right (% cycle lenght), Stance phase duration on the left and on the right (% cycle), Swing phase duration on the left and on the right (% cycle), Double gait support duration on the left and on the right (% cycle). Patient’s observational and instrumental evaluation was performed under 4 conditions: 1) without AFO or in free walk; 2) wearing a Codivilla spring; 3) wearing a FRAFO (Toe-Off); and 4) wearing a DAFONS. Main outcomes and results A task-specific evaluation was made at time T0 (clinical and functional outpatient evaluation), time T1 (1 week from T1, planning stage of DAFONS manufacturing), time T2 (3 days from T1, DAFONS custom-made manufacturing and orthoses proof before delivery), and time T3 (10 days from T2, delivery and evaluation of DAFONS approriateness) using: a. objective gait analysis (VGA), b. spatio-temporal BTS-G Walk sensor gait analysis by using a wireless device consisting of a triaxial accelerometer and gyroscope with a magnetometer inside. After our comprehensive evaluation we observed at time T3: an amelioration of gait quality (increase of patient’s trunk and hip dynamic stability, amelioration of the knee and ankle orthostatic and orthodynamic control on the affected and unaffected side) with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re- learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability; a different trend of spatio-temporal raw data in each patient in our study conditions; a decrease of test duration by using DAFONS that cannot be observed in the other study conditions in all patients; an increase of test duration in patient P1 and P5 (> in P5) compared to patients P2, P3 and P4 by using Toe-Off orthosis that cannot be observed by using Codivilla spring and DAFONS; in line with the non parametric Friedman test, a statistical significant difference [Χ2(3)=9; p=0,029] in the test duration (sec) by using Toe-Off orthosis vs DAFONS (76,62 vs 51,04) (Z=-2,023; p<0,05) and by using Codivilla spring vs Toe-Off orthosis (57,44 vs 76,62 (Z=-2,023; p<0,05); no statistical significant differences in the comparative BTS spatio-temporal analysis of the other study conditions (FW vs Codivilla, FW vs Toe-Off, FW vs DAFONS and Codivilla vs DAFONS). Conclusions In line with our observational gait analysis (VGA), we observed that by correcting the static alignment and physisological range of movement of patient’s ankle joint with the use of DAFONS we can influence and modulate the static and dynamic knee attitude and patient’s postural stability during gait. We also concluded that fine tuning to an individual patient can be achieved by adjusting the degree of AFO’s exoskeleton hardness through a specific carbon structure or by changing three mechanical properties of our ankle joint: a. orthosis ankle joint alignment, b. spring force, c. ankle joint range of motion (ROM).