Evaluation of True Ankle Motion Following Total Ankle Replacement Utilizing XROMM technology

Abstract

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is common tool used by the foot and ankle specialist to treat end stage ankle arthritis. Current data about ankle motion following TAR is derived from gait analysis utilizing external markers. Utilizing Xray Reconstruction of Moving Morphology (XROMM), which combines 3-D mapping technology with biplanar fluoroscopy in vivo to visualize true skeletal motion, we can evaluate true motion of TAR implants. Current TAR replacement systems are either mobile bearing or fixed bearing. We hypothesized that subjects implanted with a fixed bearing prosthesis would exhibit less tibiotalar rotation and translation than subjects implanted with a mobile bearing prosthesis. Methods: Six subjects with total ankle replacement at least one-year post implantation gave informed consent before participating (IRB #H16496). Three subjects with a mobile bearing prosthesis with an average age 63.3+-11.1 yrs were compared to three matched subjects with a fixed bearing prosthesis with an average age of 64.7+-1.5 yrs. Utilizing 3D slicer software, lower body CT scans for each subject were evaluated to create 3D models of the foot and ankle bones and implant components. All subjects walked for several trials at a self-selected pace along a walkway while their foot and ankle motions were captured by a high-speed biplanar fluoroscopic x-ray motion analysis (XMA) system. The 3D models were combined with the x-ray images within a 3D animation platform and rotoscoped to resolve accurate kinematic motions at the tibiotalar joint during stance phase of gait. We examined for differences between the two groups using a two-sample t-test (p<0.05). Results: Subjects with a mobile-bearing prosthesis demonstrated mean ROM’s of 7.4+-1.1°, 5.3+-2.3° and 7.1+-4.3° for dorsiflexion/plantarflexion, inversion/eversion, and internal/external rotation, respectively. Subjects with a fixed bearing ankle prosthesis did not exhibit significantly different mean ROM’s for dorsiflexion/plantarflexion (9.1+-4.0°, p=0.35), inversion/eversion (4.4+-2.1°, p=0.42), and internal/external rotation (9.0+-3.4°, p=0.35), respectively. Subjects with a fixed bearing prosthesis displayed significantly more translation along the anteroposterior (3.6+-1.2mm, p<0.01) and mediolateral (2.2+-0.7mm, p<0.01) axes compared to the mobile bearing prosthesis (1.8+-1.2mm and 1.3+-0.8mm, respectively). Conclusion: Our preliminary results indicate that mobile and fixed bearing prosthesis provides similar angular motion at the tibiotalar joint, however, the fixed bearing prosthesis exhibits greater translational motion during walking. Further, there is the same amount of internal and external translation with both component designs. The implications of this work on success or failure of current implant designs is beyond the scope of this study but this work will provide the basis for future studies to help determine optimal future total ankle replacement designs.