Kinematic changes after fusion and total replacement of the ankle - Part 1: Range of motion

Background: The purpose of this study was to determine how closely the present designs of ankle prostheses mimic the unique requirements of the foot and ankle. The three-dimensional range of motion (ROM) of the ankle joint complex, before and after ankle arthrodesis and after implantation of three currently used total ankle prostheses, was investigated. Methods: The three-dimensional ROM was determined in six fresh-frozen cadaver leg specimens using a 6-df device with an axial load of 200 N and a four-camera high-speed video system. A moment of 100 Nm was applied to the footplate to determine the ROM in the sagittal (dorsiflexion and plantarflexion) and frontal (inversion and eversion) planes. The same moment was applied to the tibia to determine the ROM for the internal and external tibial rotation. The measurements were performed for the normal ankle, the fused ankle, and the AGILITY, HINTEGRA, and S.T.A.R. prostheses. Results: Compared to the normal condition, the ROM for dorsiflexion and plantarflexion was changed for all surgical interventions. The changes were highest for the ankle arthrodesis. The changes due to the prostheses were significantly less than the changes due to ankle arthrodesis. Compared to the normal condition, the total ROM for inversion/eversion was slightly decreased by fused ankle and not changed by the three-component prostheses (HINTEGRA, S.T.A.R.). However, the ROM for inversion/eversion was significantly higher for the two-component prosthesis, AGILITY. The ROM for internal and external tibial rotation was not altered by the AGILITY and HINTEGRA ankle, but it was significantly reduced by the ankle arthrodesis. S.T.A.R. showed a significant shift of the total ROM toward internal tibial rotation. Conclusions: The three tested ankle joint prostheses changed the ROM of the ankle joint complex less than ankle fusion did. Total ankle prostheses were shown to replicate normal joint ROM closely. However, ankle arthrodesis was found to reduce the ROM substantially in all three planes: the sagittal, frontal, and horizontal planes. Clinical Implications: With respect to the ROM, total ankle replacement changes the natural ankle joint condition less than ankle arthrodesis, which reduces the ROM in all three planes and might increase stress in adjacent structures. The prosthesis that replicated the normal ankle joint ROM best was the one with the most anatomical design.