Roney Andrew R, Kraszewski Andrew P, Demetracopoulos Constantine A, Hillstrom Howard J, Deland Jonathan T, de Cesar Netto Cesar, Saito Guilherme H, Day Jonathan, Ellis Scott J
Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2022 Aug;18(3):408-417. doi: 10.1177/15563316211007839. Epub 2021 Apr 14.
: Previous literature suggests that patients treated with total ankle arthroplasty (TAA) versus ankle arthrodesis (AA) may have better function and lower risk for adjacent joint arthritis in the foot. Little is known on how these interventions affect proximal joints such as the knee. : We sought to assess whether patients with TAA and AA exhibited altered biomechanics linked to the onset and progression of knee osteoarthritis (KOA). We used the knee adduction moment (KAM), a surrogate measure for the mechanical load experienced at the medial tibiofemoral compartment, because it is linked with the onset and progression of KOA. : At a minimum of 2 years postoperatively, instrumented 3-dimensional walking gait was recorded in 10 TAA and 10 AA patients at self-selected walking speeds. TAA patients had either a Salto Talaris or INBONE prosthesis. Average first and second peak KAMs (Nm/kg), KAM impulse (Nm-s/kg), and range-of-motion (ROM, °) were calculated on both the affected and unaffected limbs for each patient. : There were no significant differences in the KAM's first and second peaks, impulse, or knee ROM in any plane between the unaffected and affected limbs, or between TAA and AA. : TAA and AA may not meaningfully affect ipsilateral knee kinetics and KAMs in short-term follow-up. This study highlights the importance of continuing to study these parameters in larger cohorts of patients with longer follow-up to determine how our treatment of end-stage ankle arthritis may affect the incidence or progression of ipsilateral KOA.
以往文献表明,与踝关节融合术(AA)相比,接受全踝关节置换术(TAA)治疗的患者可能具有更好的功能,且足部相邻关节患关节炎的风险更低。对于这些干预措施如何影响诸如膝关节等近端关节,我们知之甚少。
我们试图评估接受TAA和AA治疗的患者是否表现出与膝关节骨关节炎(KOA)的发生和进展相关的生物力学改变。我们使用膝关节内收力矩(KAM),它是衡量胫股内侧间室所承受机械负荷的替代指标,因为它与KOA的发生和进展有关。
术后至少2年,记录了10例接受TAA治疗的患者和10例接受AA治疗的患者以自选步行速度进行的三维仪器化步行步态。接受TAA治疗的患者使用的是Salto Talaris或INBONE假体。计算了每位患者患侧和未患侧肢体的平均第一和第二峰值KAM(牛顿米/千克)、KAM冲量(牛顿米-秒/千克)以及活动范围(ROM,度)。
在未患侧和患侧肢体之间,以及TAA组和AA组之间,KAM的第一和第二峰值、冲量或任何平面的膝关节ROM均无显著差异。
在短期随访中,TAA和AA可能不会对同侧膝关节动力学和KAM产生有意义的影响。这项研究强调了继续在更大规模的患者队列中进行更长时间随访来研究这些参数的重要性,以确定我们对终末期踝关节关节炎的治疗可能如何影响同侧KOA的发病率或进展。