Inverted and everted slope walking leads to increased knee compensation in ankle fusion compared to total ankle replacement

N.Z Safdar, G. Chapman, J. Hopwood, C. Brockett, A. Redmond

Background: Ankle fusion (AF), a durable intervention for ankle arthritis, has been the management of choice but restricts mobility. Recently, total ankle replacement (TAR) has been offered to patients looking to maintain mobility. The aim was to compare the biomechanics of AF and TAR while walking on inverted and everted slopes which create a greater demand for complex foot mobility than level walking. 

Methods: A ten-camera motion detection setup captured trials as patients walked in both directions over a 5⁰ lateral slope with embedded force plates. Moments (Nm/Kg) across the knee and ankle were exported from Visual 3D in the sagittal and frontal plane, and data were reported as means with 95% confidence intervals.

Results: 15 patients were recruited (6 TAR, 9 AF). The median age, follow-up and BMI was 67 years, 4 years and 35.8 kg/m² in AF, and 73 years, 7 years and 28.1 kg/m² in TAR, respectively. During inverted slope walking (4 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.38 (0.37-0.39) vs AF 0.37 (0.27-0.52) and (ii) the ankle: TAR 0.20 (0.13-0.27) vs AF 0.25 (0.18-0.32), and extension moments across (i) the knee: TAR 0.68 (0.38-0.97) vs AF 0.85 (0.69-1.01) and (ii) the ankle: TAR 1.46 (1.30-1.62) vs AF 1.30 (1.08-1.52). During everted walking (5 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.41 (0.30-0.52) vs AF 0.46 (0.27-0.66) and (ii) the ankle: TAR 0.24 (0.11-0.38) vs AF 0.26 (0.18-0.33), and extension moments across (i) the knee: TAR 0.76 (0.54-0.99) vs AF 0.93 (0.72-1.14) and (ii) the ankle: TAR 1.39 (1.19-1.59) vs AF 1.26 (1.04-1.48).

Conclusions: There were no differences in abduction moments during inverted or everted slope walking. However, patients with AF had increased extension moments across the knee, particularly on inverted slopes, suggesting that AF creates a greater demand for knee compensation than TAR.