The Biomechanical Behavior of Distal Foot Joints in Patients with Isolated, End-Stage Tibiotalar Osteoarthritis Is Not Altered Following Tibiotalar Fusion.

Maarten Eerdekens,Sander Wuite,Kevin Deschamps,Giovanni Matricali

doi:10.3390/jcm9082594

Maarten Eerdekens, Sander Wuite + Show 2 more

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https://doi.org/10.3390/jcm9082594

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Abstract

Ankle arthrodesis is considered to be an optimal treatment strategy to relieve pain during walking in patients with isolated, end-stage tibiotalar osteoarthritis. The aim of this study was to investigate the post-operative effect of an arthrodesis on the ankle and foot joint biomechanics. We included both patients (n = 10) and healthy reference data (n = 17). A multi-segment foot model was used to measure the kinematics and kinetics of the ankle, Chopart, Lisfranc, and first metatarsophalangeal joints during a three-dimensional (3D) gait analysis. These data, together with patient reported outcome measures, were collected at baseline (pre-operative) and one year post-operatively. Patients experienced a decrease in pain and an increase in general well-being after surgery. Compared to the baseline measurements, patients only demonstrated a significant average post-operative increase of 0.22 W/kg of power absorption in the ankle joint. No other significant differences were observed between baseline and post-operative measurements. Current findings suggest that the biomechanical behavior of distal foot joints is not altered one year after fusion. The pain relief achieved by the arthrodesis improved the loading patterns during walking. Clinical significance of this study dictates that patients do not have to fear a loss in biomechanical functionality after an ankle arthrodesis.

Highlights

Tibiotalar osteoarthritis (OA) is a disabling disorder characterized by progressive joint degeneration, pain, and functional impairments causing difficulties during daily life activities, such as walking [1,2]
The findings in this study revealed an interesting biomechanical phenomenon, in which patients with end-stage tibiotalar OA demonstrated a walking pattern that may originate from pain-mediated stiffness and inherent biomechanical deficiencies, as if they already possessed a functional arthrodesis
It can be reasoned that the primary purpose of an ankle arthrodesis is to relieve pain in the tibiotalar joint without compromising the pre-operative gait biomechanics

Summary

Introduction

Tibiotalar osteoarthritis (OA) is a disabling disorder characterized by progressive joint degeneration, pain, and functional impairments causing difficulties during daily life activities, such as walking [1,2]. Brodsky et al found an increased ankle joint RoM after a tibiotalar fusion [9] In their rationale, the authors stated that regardless of the articulations across which sagittal plane movement occurs post-operatively, some patients experience the persistence of mobility rather than the expected dramatic increase in stiffness. The authors stated that regardless of the articulations across which sagittal plane movement occurs post-operatively, some patients experience the persistence of mobility rather than the expected dramatic increase in stiffness These contradictory findings might be attributed to methodological discrepancies between both studies, as the latter used a one-segment kinematic foot model, which leads to opposite results on ankle joint kinematics during gait [10]

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