Bilateral differences in gait mechanics following total ankle replacement

Ankle arthritis is a debilitating condition that may lead to deformity severe pain, functional disability, biomechanical changes, cartilage breakdown, and subsequent gait dysfunction. While most hip and knee arthritis cases are primary, 70% of ankle arthritis is post-traumatic and the majority of remaining cases are caused by systemic disorders. Although gait changes and pain are the most notable signs and symptoms in patients with ankle arthritis, other measures such as quality of life and self-reported physical function are affected significantly with increasing ankle arthritis severity. 

The purpose of this study was to assess the changes in gait symmetry from a pre-operative assessment through two years following total ankle replacement (TAR). 

The results of this study indicate that fixed-bearing TAR is effective at improving gait mechanics in patients with painful end-stage ankle arthritis. In addition, TAR resulted in maintenance of ankle dorsiflexion during the stance phase; however, a decrease in dorsiflexion angle was present at heel strike on the operative side when compared with the non-operative side up to 2 years following TAR. Finally, following TAR the asymmetry in temporal gait variables and peak plantar flexion moment were improved. However, differences did remain between the operative and non-operative limbs for stance, step, and swing time as well as the peak plantar flexion moment 2 years following TAR. The remaining gait asymmetry is of potential concern because of possible over loading of the contralateral limb and compensatory walking mechanics that could lead to secondary injuries following TAR. > From: Queen et al., Clin Biomech 29 (2014) 418–422. 

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