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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 186 - 186
1 Sep 2012
Fong J Dunbar MJ Wilson DA Hennigar A Francis P Glazebrook M
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Purpose

The purpose of this study was to assess the clinical outcomes over two years for total ankle arthroplasty (TAA) using Short Form-36, Foot Function Index and Ankle Osteoarthritis Scores, and to compare these with radiostereometric analysis longitudinal migration and inducible displacement results.

Method

Twenty patients undergoing TAA implanting the Mobility Total Ankle System (DePuy, Warsaw IN) were assessed at 3mth, 6mth, 1yr and 2yr followup periods by model-based radiostereometric analysis, MBRSA 3.2 (Medis specials, Leiden, The Netherlands), for longitudinal migration (LM) and inducible displacement (ID). The same subjects completed clinical outcome questionnaires at these followup periods for Short Form-36 (SF-36; Physical Component Scores (PCS) and Mental Component Scores (MCS)), Foot Function Index (FFI) and Ankle Osteoarthritis Scores (AOS). Descriptive statistics and Pearson correlations (alpha = 0.05) were calculated using Minitab 15 (Minitab Inc., State College PA).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 46 - 46
1 Sep 2012
Fong J Dunbar MJ Wilson DA Hennigar A Francis P Glazebrook M
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Purpose

The purpose of this study was to assess the biomechanical stability of the a total ankle arthroplasty system using longitudinal migration (LM) and inducible displacement (ID) measures. This study is the first study of its kind to assess total ankle arthroplasty (TAA) implant micromotion using model-based radiostereometric analysis (MBRSA).

Method

Twenty patients underwent TAA that implanted the Mobility(TM) (DePuy, Warsaw IN). The mean (SD) age was 60.4 (12.5) and BMI was 29.1 (2.8) kg/m2. One surgeon performed all surgeries. All patients included in this study had given informed consent. Capital Health Research Ethics Board had approved this study.

Uniplanar medial-lateral RSA X-ray exams were taken postop (double exam), at six wk, three mth, six mth, one yr and two yr followup times using a supine, unloaded position. Standing medial-lateral exams were taken at three mth, six mth, one yr and two yr followup intervals.

LM and ID micromotions were assessed using Model-based RSA 3.2 software (Medis specials, Leiden, The Netherlands). Implant micromotions (x, y, z, Rx, Ry, Rz, MTPM) were determined and assessed for each subject using model-based pose estimation, and the implant-based coordinate system. The Elementary Geometric Shapes module from the Model-based RSA 3.2 software was used to assess the micromotion of the tibial component spherical tip due to implant symmetry.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 93 - 93
1 Sep 2012
Wilson DA Dunbar MJ Richardson G Hennigar A
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Purpose

To evaluate the five year Radiostereometric Analysis (RSA) results of the NexGen LPS Trabecular Metal Tibial Monoblock component (TM) and the NexGen Option Stemmed cemented component (Cemented), (Zimmer, Warsaw IN).

Method

70 patients with osteoarthritis were included in a randomized series to receive either the TM implant or the cemented NG component. Surgery was performed by high volume arthoplasty specialists using standardized procedure. RSA exams were obtained postoperatively, at six months, one year, two years and five years. RSA outcomes were translations, rotations and maximum total point motion (MTPM) of the components. MTPM values were used to classify implants as ‘at risk’ or ‘stable’. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were gathered at all follow-ups.

An analysis of variance was used to test for differences in age, body mass index (BMI), and subjective measures between implant groups. The Kruskal-Wallis test was used to investigate differences in maximum total point motion between implant groups. An analysis of variance was used to test for differences in translations and rotations between groups. Fishers exact test was used to investigate differences in proportions of implants found to be at risk between groups.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 55 - 55
1 Sep 2012
Wilson DA Dunbar MJ Fong J Glazebrook M
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Purpose

To compare Radiostereometric Analysis (RSA) and subjective outcomes of Total Knee Arthroplasty (TKA) and Total Ankle Arthroplasty (TAA).

Method

Twenty-five patients were recruited to receive TKA (Zimmer, NexGen LPS Trabecular Metal Monoblock) and 20 patients were recruited to receive TAA (DePuy, Mobility). The tibial component of the TKA and the tibial component of the TAA were followed for two years with RSA with exams postoperatively at six, 12 and 24 months. At two years, inducible displacement RSA at the knee and ankle was also performed. RSA outcomes measured were translations in the anterior-posterior, medial-lateral and distal-proximal directions of both implants. SF-36 outcome questionnaires were completed preoperatively and at each RSA follow-up with the outcome being the mental component score (MCS) and physical component score (PCS). Analysis of variance statistical testing was used to compare RSA outcomes and subjective outcomes.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 558 - 558
1 Nov 2011
Wilson DA Hubley-Kozey C Dunbar MJ Wilson JLA
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Purpose: The goal of this study was to investigate if musculoskeletal activation patterns measured with electromyography (EMG) are predictive of migration of total knee replacements (TKR) measured with radiostereometric analysis (RSA).

Method: 37 TKR patients who were part of a larger randomized controlled RSA trial were recruited to this study. Study participants had been randomized to receive the Nexgen LPS Trabecular Metal tibial monoblock component (n = 19), or the cemented NexGen Option Stemmed tibial component (n = 18) (Zimmer, Warsaw IN). Ethics approval was received from the institutional review board. In the week prior to their surgery, the patients went to the dynamics of human motion laboratory and underwent EMG data collection. Surface electrodes were placed over the vastus lateralis, vastus medialis, rectus femoris, the lateral and medial hamstrings, and the lateral and medial gastrocnemius using standardized placements (Hubley-Kozey et al., 2006). The variability in subject EMG patterns was captured with a set of discrete scores that represented weightings on objectively-extracted features of the gait waveform data using principal component analysis (PCA). Within four days of surgery and at six months post-operatively, patients had bi-planar knee x-rays taken. RSA analysis was performed with MB-RSA (MEDIS, Leiden). RSA results were reported as maximum total point motion (MTPM), and six degrees of freedom translations and rotations at six months.

Results: A correlation was found between the third principle component of the lateral gastrocnemius muscle (representing high gastrocnemius activation in late stance) and the anterior migration of the component (R2=0.247 P=0.002). A correlation was found between the vastus medialis principle component three (representing low vastus medialis activation in late stance) and the anterior migration of the component (R2= 0.338, P=0.000). A stepwise regression model was developed for anterior migration of the tibial component. To reduce the number of terms in the model only the two EMG variables that were correlated with anterior migration, implant type and BMI were entered leaving four possible terms. The stepwise regression eliminated all variables but the lateral gastrocnemius and the vastus medialis. The regression equation was Anterior-Posterior Migration = 0.01 +0.12*Vastus Medialis PC3 + 0.074*Lateral Gastrocnemius PC3 (R2=0.487, R2 Adj=0.457, P< 0.0001)

Conclusion: It has previously been shown that anterior shear on the tibial component of TKR is temporally localized to the last third of stance phase of gait. Both the gastrocnemius and vastus muscle groups have the ability to produce large anterior posterior shear on an the knee during late stance. This result shows that variables which capture the temporal activation patterns of these muscles preoperatively are related to the migration of the tibial component of TKR postoperatively. This may have implications for rehabilitation of these patients.