Barylak Martin, Arena Sara L, Carpentier Stephanie H, Queen Robin M
Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
J Orthop Res. 2025 Feb;43(2):388-395. doi: 10.1002/jor.25992. Epub 2024 Oct 10.
End-stage ankle arthritis is often treated surgically by total ankle arthroplasty (TAA) due to its potential to improve gait through increased joint range of motion and reduce pain. However, TAA's effect on gait stability is not well understood. This study explores the impact of TAA on gait stability, measured by Margin of Stability (MoS), in 148 patients with end-stage ankle arthritis. Kinematic data were collected pre-operatively, at 1-year post-op, and at 2-years post-op and the MoS was determined at heel strike and midstance for the anteroposterior (MoS) and mediolateral (MoS) directions. A linear mixed effects model including gait speed as a factor was used to assess the effects of limb, session, and their interaction on outcome measures. A significant interaction (p < 0.002) between limb (surgical, nonsurgical) and session (pre-op, 1-year post-op, 2-years post-op) was identified for each MoS variable of interest. Cumulatively, our results suggest that the nonsurgical limb, MoS at heel strike and MoS at midstance improved (increased) as time from surgery increased. These results suggest patients developed a compensatory movement pattern to navigate surgical limb single support. TAA reduces this compensation improving side-to-side symmetry, while not fully restoring symmetry by 2-years post-op. These results indicate that TAA could improve gait stability in patients with end-stage ankle arthritis, but further work is needed to understand the impact of TAA on altering fall risk.
终末期踝关节关节炎通常通过全踝关节置换术（TAA）进行手术治疗，因为它有可能通过增加关节活动范围来改善步态并减轻疼痛。然而，TAA对步态稳定性的影响尚不清楚。本研究探讨了TAA对148例终末期踝关节关节炎患者步态稳定性的影响，通过稳定性 margin（MoS）来衡量。术前、术后1年和术后2年收集运动学数据，并在足跟触地和支撑中期确定前后方向（MoS）和内外侧方向（MoS）的MoS。使用包括步态速度作为一个因素的线性混合效应模型来评估肢体、时间段及其相互作用对结果指标的影响。对于每个感兴趣的MoS变量，在肢体（手术侧、非手术侧）和时间段（术前、术后1年、术后2年）之间发现了显著的相互作用（p < 0.002）。总体而言，我们的结果表明，随着手术时间的增加，非手术侧肢体在足跟触地时的MoS和支撑中期的MoS有所改善（增加）。这些结果表明患者形成了一种代偿性运动模式来应对手术侧肢体单支撑。TAA减少了这种代偿，改善了左右对称性，但术后2年并未完全恢复对称性。这些结果表明，TAA可以改善终末期踝关节关节炎患者的步态稳定性，但需要进一步的研究来了解TAA对改变跌倒风险的影响。
