Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis

TY - JOUR

T1 - Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis

T2 - An in Vivo Dual-Fluoroscopy Imaging Study

AU - Lenz, Amy L

AU - Nichols, Jennifer A

AU - Roach, Koren E

AU - Foreman, K Bo

AU - Barg, Alexej

AU - Saltzman, Charles L

AU - Anderson, Andrew E

PY - 2020/4/1

Y1 - 2020/4/1

N2 - BACKGROUND: Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle.METHODS: Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured.RESULTS: During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°).CONCLUSIONS: A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis.CLINICAL RELEVANCE: Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.

AB - BACKGROUND: Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle.METHODS: Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured.RESULTS: During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°).CONCLUSIONS: A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis.CLINICAL RELEVANCE: Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.

KW - Adult

KW - Arthrodesis

KW - Cohort Studies

KW - Female

KW - Fluoroscopy/methods

KW - Humans

KW - Male

KW - Middle Aged

KW - Osteoarthritis/etiology

KW - Postoperative Complications/etiology

KW - Range of Motion, Articular

KW - Retrospective Studies

KW - Subtalar Joint/diagnostic imaging

KW - Talus/surgery

KW - Tibia/surgery

KW - Walking

U2 - 10.2106/JBJS.19.01132

DO - 10.2106/JBJS.19.01132

M3 - SCORING: Journal article

C2 - 32079879

VL - 102

SP - 600

EP - 608

JO - J BONE JOINT SURG AM

JF - J BONE JOINT SURG AM

SN - 0021-9355

IS - 7

ER -