Article

Gait mechanics following total ankle replacement (TAR) have reported
improved ankle motion following surgery. However, no studies have addressed the
impact of preoperative radiographic tibiotalar alignment on post-TAR gait
mechanics. We therefore investigated whether preoperative tibiotalar alignment
(varus, valgus, or neutral) resulted in significantly different coronal plane
mechanics or ground reaction forces post-TAR. METHODS: We conducted a
non-randomized study of 93 consecutive end-stage ankle arthritis patients.
Standard weight-bearing radiographs were obtained preoperatively to categorize
patients as having neutral (+/-4 degrees ), varus (>/=5 degrees of varus), or
valgus (>/=5 degrees of valgus) coronal plane tibiotalar alignment. All patients
underwent a standard walking assessment including three-dimensional lower
extremity kinetics and kinematics preoperatively, 12 and 24 months
postoperatively. RESULTS: A significant group by time interaction was observed
for the propulsive vertical ground reaction force (vGRF), coronal plane hip range
of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated
an increase in the peak knee adduction angle and knee adduction angle at heel
strike when compared to the other groups. Coronal plane ankle ROM, knee and hip
angles at heel strike, and the peak hip angle exhibited significant increases
across time. Peak ankle inversion moment, peak knee abduction moment and the
weight acceptance vGRF also exhibited significant increases across time. Neutral
ankle alignment was achieved for all patients by 2 years following TAR.
CONCLUSIONS: Restoration of neutral ankle alignment at the time of TAR in
patients with preoperative varus or valgus tibiotalar alignment resulted in
biomechanics similar to those of patients with neutral preoperative tibiotalar
alignment by 24-month follow-up.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

Langue : ANGLAIS