Unipedal Balance Is Affected by Lower Extremity Joint Arthroplasty Procedure 1 Year Following Surgery

Butler, Robert J.; Thiele, Ramon A. Ruberte; Barnes, C. Lowry; Bolognesi, Michael P.; Queen, Robin M.

doi:10.1016/j.arth.2014.08.031

Cited by 18 publications

(14 citation statements)

References 47 publications

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“…All participants were diagnosed with end‐stage ankle osteoarthritis by a foot and ankle trained orthopedic surgeon, and were scheduled for a total ankle replacement within 2 weeks of testing. To be included in this study, all participants had to be capable of independent ambulation without the use of an assistive device and were required to be able to maintain unassisted bilateral, quiet, upright stance for 10 s. This 10‐s duration of quiet standing has been suggested to be clinically meaningful in identifying individuals at increased risk of falling . Participants were excluded if they had experienced or been diagnosed with pain or degeneration of other ipsilateral or contralateral lower extremity joints (knee or hip), had a history of lower extremity joint arthroplasty or spinal surgery, had a previous ankle arthrodesis, or experienced any other proprioceptive deficiency that affected their activities of daily living.…”

Section: Methodsmentioning

confidence: 99%

Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Gladish

Powell

Allison

et al. 2017

Journal Orthopaedic Research

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Ankle osteoarthritis (OA) compromises ankle joint stability in regards to static balance. Unilateral and bilateral osteoarthritis patients often exhibit different limb-loading patterns during static balance tasks. Symmetrical loading has been posited to improve balance performance. Therefore, the purpose of this study was to quantify balance performance in both ankle osteoarthritis patient groups. Twenty-two unilateral and twenty-one bilateral ankle osteoarthritis patients performed three 10-s quiet standing trials with their feet together. Ground reaction force data were collected from force platforms with one under each foot. Center of pressure excursion in the anteroposterior and mediolateral directions as well as the resultant center of pressure were calculated using custom Matlab software. A 2 × 2 repeated measures ANOVA with Cohen's d were used to analyze the differences between groups (unilateral vs. bilateral) and between limbs (affected vs. unaffected) (α = 0.05). No significant differences were found between limbs or groups in either the anteroposterior or mediolateral direction for any measured variable. Though not statistically different, moderate to large effect sizes were observed for mean resultant distance between unilateral and bilateral (d = 0.096, d: 1.0) as well as anteroposterior excursion (p = 0.077, d: 1.731) and mean velocity (p = 0.084, d: 1.50) between affected and unaffected limbs. These large effect sizes suggested clinically relevant differences may exist, particularly in the anteroposterior direction. These findings may suggest that center of pressure is a better measure of postural strategy while center of mass measures may be more representative of postural steadiness. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2749-2754, 2017.

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Section: Methodsmentioning

confidence: 99%

Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Gladish

Powell

Allison

et al. 2017

Journal Orthopaedic Research

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“…Most of the work on OA summarized above has focused on understanding the impact that ankle osteoarthritis and TAA have on lower extremity gait mechanics and associated energy exchange. More recent work has begun to examine how static balance is impacted by these ankle pathologies with the goal of understanding how to alter patient care to improve outcomes and decrease fall risk in these patients …”

Section: Ankle Arthritis and Lower Extremity Biomechanicsmentioning

confidence: 99%

“…Our initial study examining balance in this patient population was a comparative study between total hip, total knee, and total ankle replacement patients . This study explored the impact of lower extremity (hip, knee, and ankle) joint replacement on single leg balance 1 year following surgery.…”

Section: Ankle Arthritis and Lower Extremity Biomechanicsmentioning

confidence: 99%

“…This study explored the impact of lower extremity (hip, knee, and ankle) joint replacement on single leg balance 1 year following surgery. The results of this study demonstrated that 63% of total hip replacement patients, 69% of total knee replacement patients, and only 9% of total ankle replacement patients were able to maintain single leg stance on each limb for greater than 5 s, while literature based age‐matched healthy subjects had an average single leg stance time of 25 s . Due to the difficulty these patients had in completing single limb balance we decided to expand our balance assessments to include a series of bilateral balance tasks based on a portion of the Short Physical Performance Battery in four different postures (feet shoulder width apart, feet together, semi‐tandem, and tandem stance) .…”

Section: Ankle Arthritis and Lower Extremity Biomechanicsmentioning

confidence: 99%

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Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty

Queen

2017

Journal Orthopaedic Research

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Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017.

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“…Butler et al demonstrated that patients with total ankle arthroplasty had significantly poorer balance compared to those following hip or knee arthroplasty, suggesting the greater importance of the ankle in maintaining balance [117].…”

Section: Hypothesismentioning

confidence: 99%

The inter-relationship between clinical outcomes as measured by sagittal plane alignment of implant components, peri-operative kinematics, clinical ratings systems, strength, balance and functional performance assessment in patients post Total Knee Arthroplasty

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Unipedal Balance Is Affected by Lower Extremity Joint Arthroplasty Procedure 1 Year Following Surgery

Cited by 18 publications

References 47 publications

Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty

The inter-relationship between clinical outcomes as measured by sagittal plane alignment of implant components, peri-operative kinematics, clinical ratings systems, strength, balance and functional performance assessment in patients post Total Knee Arthroplasty

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