Kinematic Changes After Fusion and Total Replacement of the Ankle Part 3: Talar Movement

Abstract

Introduction: The purpose of this study was to determine talar movement (e.g., talar rotation and talar shift during (dorsiflexion/plantarflexion) with respect to the tibia in the normal ankle, in the fused ankle, and in the replaced ankle by currently used prosthetic designs. Methods: A 6-df device with an axial load of 200 N and a four-camera high-speed video system were used for the measurement of the range of motion in six fresh-frozen cadaveri leg specimens. While moving the foot through the whole range of motion for plantarflexion/dorsiflexion, segmental motion of the marked bones of the foot and shank were measured dynamically. Rotation and medial-lateral shift of the talus were then calculated with regard to flexion position of the foot. Results: In the normal ankle, plantarflexion movement was coupled with talar inversion of 3.5°, and dorsiflexion movement with talar eversion of 1.0°, in totally accounting for 4.5° of talar rotation. While both the HINTEGRA and the S.T.A.R. prostheses did not show changes to the normal condition during the dorsiflexion/plantarflexion cycle (p <.05), talar rotation had a 60% decrease (p <.05) for the AGILITY prosthesis. In the normal ankle joint, a lateral talar shift of 1.4 mm was found to occur during dorsiflexion, and a lateral talar shift of 5.2 mm during plantarflexion. In both, the HINTEGRA and S.T.A.R. ankles, talar shift was converted into medial direction during dorsiflexion of the foot (difference to normal: p <.05), whereas talar shift in the lateral direction was found to occur during plantarflexion of the foot which was comparable to the normal ankle. The AGILITY ankle evidenced an 80% decrease of talar shift (p < .05) during the whole dorsiflexion/plantarflexion cycle. Discussion: The two-component ankle (AGILITY) obviously tends to restrict tremendously talar motion within the ankle mortise, whereas the three-component ankles (HINTEGRA, S.T.A.R.) seem to allow talar range of motion comparable to that in the normal ankle. It is suggested that such a restriction of talar motion results in an increase of stress forces within and around the prosthesis, leading to polyethylene wear and potential loosening at the bone–implant interfaces. Therefore, a successful prosthetic design for the ankle should consist of three components that are shaped as anatomically as possible to provide a normal range of motion and to allow the full transmission of movement transfer between foot and shank and unconstrained movement of the talus within the ankle mortise.