title: Ratio of Range of Motion of the Ankle and Surrounding Joints After Total Ankle Replacement: A Radiographic Cohort Study.
abstract: BACKGROUND
  This study attempted to identify where motion occurs after total ankle replacement, the difference in range-of-motion contributions between fixed-bearing and mobile-bearing total ankle replacements, and the contribution of abnormal peritalar motion. We hypothesized that sagittal plane radiographic assessment would demonstrate that actual ankle motion through the prosthesis is less than the total arc of ankle motion that may be observed clinically secondary to contributions from adjacent joints.
  
  
  METHODS
  Patients underwent routine standardized weight-bearing maximum dorsiflexion and plantar flexion sagittal radiographs. Sagittal plane ankle and foot measurements were performed on each dorsiflexion and plantar flexion radiograph to determine the total arc of ankle motion, actual ankle motion through the prosthesis, motion through the subtalar and talonavicular joints, and midfoot motion. Motion radiographs were routinely made at 1 year postoperatively and at the time of the most recent follow-up. A minimum follow-up of 2 years was required of all patients.
  
  
  RESULTS
  There were 197 patients who met the inclusion criteria (75 INBONE, 52 Salto Talaris, and 70 STAR prostheses). The mean time to the latest radiographs (and standard deviation) was 42.9 ± 18.8 months. The mean actual ankle motion through the prosthesis was 25.9° ± 12.2°, which was significantly less (p < 0.001) than the mean total motion arc of 37.6° ± 12.0°. The motion of the ankle accounted for 68% of total range of motion, and motion of the peritalar joints accounted for 32%. There was no significant difference (p > 0.05) among the 3 prostheses or when comparing fixed and mobile-bearing designs for both ranges of motion.
  
  
  CONCLUSIONS
  This study demonstrates that actual ankle motion after total ankle replacement is approximately 12° less than the total arc of motion that might be observed clinically because of increased midfoot and subtalar motion.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Dekker
authors.forename: Kamran S
authors.initials: KS
authors.lastname: Hamid
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
authors.forename: James K
authors.initials: JK
authors.lastname: DeOrio
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000502:physiology*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D058737:Arthroplasty, Replacement, Ankle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*