Baylor University Medical Center, Dallas, TX, USA.
OrthoArizona, Scottsdale, AZ, USA.
Foot Ankle Int. 2021 May;42(5):527-535. doi: 10.1177/1071100720977847. Epub 2021 Feb 8.
Total ankle arthroplasty (TAA) is advocated over ankle arthrodesis to preserve ankle motion (ROM). Clinical and gait analysis studies have shown significant improvement after TAA. The role and outcomes of TAA in stiff ankles, which have little motion to be preserved, has been the subject of limited investigation. This investigation evaluated the mid- to long-term functional outcomes of TAA in stiff ankles.
A retrospective study of prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 (5-13) years postoperatively used 1-way analysis of variance and multivariate regression analysis to compare among preoperative and postoperative demographic data (age, gender, body mass index, years postsurgery, and diagnosis) and gait parameters according to quartiles of preoperative sagittal ROM.
The stiffest ankles had a mean ROM of 7.8 degrees, compared to 14.3 degrees for the middle 2 quartiles, and 21.0 degrees for the most flexible ankles. Patients in the lowest quartile (Q1) also had statistically significantly lower step length, speed, max plantarflexion, and power preoperatively. Postoperatively, they increased step length, speed, max plantarflexion, and ankle power to levels comparable to patients with more flexible ankles preoperatively (Q2, Q3, and Q4). They had the greatest absolute and relative increases in these parameters of any group, but the final total ROM was still statistically significantly the lowest.
Preoperative ROM was predictive of overall postoperative gait function at an average of 7.6 (range 5-13) years. Although greater preoperative sagittal ROM predicted greater postoperative ROM, the stiffest ankles showed the greatest percentage increase in ROM. Patients with the stiffest ankles had the greatest absolute and relative improvements in objective function after TAA, as measured by multiple gait parameters. At intermediate- to long-term follow-up, patients with stiff ankles maintained significant functional improvements after TAA.
Level III, comparative study.
全踝关节置换术（TAA）被提倡用于保留踝关节活动度（ROM），优于踝关节融合术。临床和步态分析研究表明 TAA 后有显著改善。对于活动度较小而无需保留的僵硬踝关节，TAA 的作用和结果一直是有限研究的主题。本研究评估了僵硬踝关节中 TAA 的中期至长期功能结果。
对前瞻性收集的 33 例 TAA 患者的功能步态数据进行回顾性研究，平均随访 7.6（5-13）年，使用单因素方差分析和多变量回归分析，根据术前矢状面 ROM 的四分位距比较术前和术后的人口统计学数据（年龄、性别、体重指数、术后时间和诊断）和步态参数。
最僵硬的踝关节平均 ROM 为 7.8 度，与中间 2 个四分位距的 14.3 度和最灵活的踝关节的 21.0 度相比。Q1 组患者术前的步长、速度、最大跖屈和功率均显著降低。术后，他们的步长、速度、最大跖屈和踝关节功率增加到与术前更灵活的踝关节组（Q2、Q3 和 Q4）相当的水平。他们在这些参数中具有最大的绝对和相对增加，但最终总 ROM 仍然显著最低。
术前 ROM 可预测平均 7.6 年（5-13 年）的术后整体步态功能。尽管更大的术前矢状面 ROM 预测了更大的术后 ROM，但最僵硬的踝关节显示了 ROM 增加的百分比最大。僵硬踝关节患者 TAA 后，多项步态参数测量的客观功能有最大的绝对和相对改善。在中期至长期随访中，僵硬踝关节患者在 TAA 后仍保持显著的功能改善。
III 级，比较研究。
