We aimed to review the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, then at 6 weeks, 6 and 12 months, and annually until 10 years post op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. Case notes were reviewed to determine intra and post-operative complications. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis(16), primary osteoarthritis(12) and post-traumatic osteoarthritis(2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 22 out of the remaining 24 were available for follow-up. Intra operative complications included lateral malleoli fracture(3) and superficial peroneal nerve injury(2). Post operative complications included 1 early death, but this was not related to the surgical procedure. Two patients developed deep infections of the prosthesis. One underwent removal of the implant; the other is on long term oral antibiotic therapy. One patient had delayed union of the syndesmosis and six patients had non-union. On clinical assessment, patients' AOFAS scores improved from mean 40.4 pre-op to 83.5 post-op (p<0.001). Radiological assessment of the tibial component revealed 25 (93%) patients had lucency in at least one zone in the AP radiograph. We found a relatively high level of re-surgery and complications following Agility total ankle replacement. A 7% revision rate is much higher than would be tolerated in knee or hip arthroplasty, but compares favourably to other studies of TAR. Despite radiological features which suggest loosening, the high rate of re-surgery and complications; patients are generally satisfied with the procedure, reporting lower levels of pain and improved function. Overall we feel that the Agility ankle is an acceptable alternative to ankle arthrodesis, however patients need to be warned of the risk of re-surgery.
Several authors have used 3D motion analysis to measure upper limb kinematics, but none have focused solely on wrist movements, in six degrees of freedom, during activities of daily living (ADL). This study aimed to determine the role of the different planar wrist movements during three standardised tasks, which may be affected by surgical procedures. Nine volunteers (age range 22-45) were recruited and each participant performed three simulated ADLs: using a door lever, a door knob and opening/closing a jam jar. The ADLs were simulated using a work-sim kit on an isokinetic dynamometer. Motion analysis was performed by a 10-camera Oqus system (Qualisys Medical AB, Gothenburg, Sweden). All raw kinematic data were exported to Visual3D (C-Motion Inc.), where the biomechanical model was defined and joint kinematics calculated. Table 1 shows a similar range of radial-ulnar deviation and flexion-extension as previous studies. However a substantial amount of wrist rotation also occurred in all tasks. This was significantly greater when using the door lever compared with the door knob and jam jar tasks. Previous studies have stated that a negligible degree of rotation occurs at the wrist. This study found a maximum mean of 31.7 degrees of wrist rotation. This indicates that considerable rotational movement occurs at the wrist during certain functional tasks. Surgical approaches and clinical pathology may disrupt structures responsible for rotational stability. Further investigation of this rotational component of carpal movement during additional ADLs is proposed in both normal and clinical subjects, to explore the potential relationship between carpal surgery and rotational laxity.
