Morphologic and Kinematic Adaptations of the Subtalar Joint after Ankle Fusion Surgery in Patients with Varus-type Ankle Osteoarthritis

内翻型踝骨关节炎患者踝关节融合手术后距下关节的形态和运动学适应

• 批准号: 10725811
• 负责人: Andrew Edward Anderson
• 金额: $ 55.13万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725811
• 关键词: 3-Dimensional; Accounting; Address; Adopted; Anatomy; Ankle; Arthritis; Arthrodesis; Biomechanics; Cartilage; Clinical; Compensation; Complex; Data; Deformity; Degenerative polyarthritis; Development; Enrollment; Exhibits; Film; Fluoroscopy; Future; Goals; Inferior; Intervention Studies; Ipsilateral; Joints; Leg; Life; Limb structure; Measures; Mechanics; Medial; Mediating; Modeling; Morphology; Motion; Operative Surgical Procedures; Outcome; Pain; Patient Outcomes Assessments; Patient Recruitments; Patient-Focused Outcomes; Patients; Physical Function; Postoperative Period; Quality of life; Recommendation; Research; Risk; Role; Scanning; Schedule; Shapes; Subtalar joint structure; Surgeon; Testing; Time; Walking; Weight-Bearing state; X-Ray Computed Tomography; base; calcaneum; clinical effect; disability; experience; experimental study; foot; improved; in vivo; insight; kinematics; pain relief; structural determinants; subchondral bone; tibia

PROJECT SUMMARY Tibiotalar arthrodesis, or ‘ankle fusion’, is the gold standard surgical treatment for posttraumatic ankle osteoarthritis (OA). Ankle fusion brings pain relief, at least in the short term; however, elimination of motion at the tibiotalar joint imposes new demands at the subtalar joint, which may exceed the limit of cartilage and result in secondary OA. Most patients undergoing ankle fusion surgery have preoperative deformities in the alignment of the tibiotalar and subtalar joints. Notably, 60% of all patients with ankle OA have varus malalignment of the tibiotalar joint. Recently, it was discovered that the ipsilateral subtalar joint adopts ‘compensatory’ valgus alignment in approximately half of those patients with varus-type ankle OA. Opposing varus-valgus deformities tend to neutralize the overall alignment of the leg and hindfoot, making it appear normal on gross clinical inspection. Unfortunately, while current surgical recommendations for ankle fusion provide clear guidance for how to correct varus malalignment of the tibiotalar joint, they make no stipulation for compensatory valgus alignment of subtalar joint. Results from our recently completed R21 project illustrate the potential for surgeons to strategically align the ankle fusion to control for postoperative motion, joint space distance, and congruency of the subtalar joint, which could in turn mediate secondary OA. Still, the specific effects of ankle fusion surgery on the form and function of the subtalar joint have not been evaluated longitudinally in-vivo. Our broad goal is to identify mechanical and structural factors that lead to inferior patient outcomes after ankle fusion. The R01 proposed herein addresses this goal through quantitative, longitudinal characterization of the effects of ankle fusion surgery on the form and function of the subtalar joint in-vivo. Here, we take a focused, mechanistic look at patients with varus ankle OA that are subdivided into two equal groups (with and without compensatory valgus alignment of the subtalar joint; n = 24 per group). Guided by our preliminary data, we hypothesize that patients with preoperative compensatory alignment of the subtalar joint are at greater risk of experiencing altered form- function relationships and inferior outcomes at 24 months post ankle fusion surgery. Aim 1 will quantify how ankle fusion changes the alignment and morphology of the subtalar joint from longitudinal statistical shape models constructed from weight-bearing computed tomography scans. Aim 2 will quantify how ankle fusion changes the in vivo kinematics of the subtalar joint during walking, stair ascent, and stair descent using dual fluoroscopy. Aim 3 will synthesize these data to identify and isolate the role preoperative alignment of the subtalar joint has on subtalar joint morphology, in vivo motion, and patient outcomes. If successful, this project will provide the first and only mechanistic understanding of the effects of ankle fusion. We anticipate that completion of these aims will also provide prerequisite information for us to pursue a future interventional study, where we would evaluate whether accounting for valgus compensation at the time of surgery yields better outcomes.

项目摘要 tibiotalar关节虫或“踝关节融合”是创伤后脚踝的金标准手术治疗 骨关节炎（OA）。踝关节融合至少在短期内减轻疼痛。但是，消除运动 tibiotalar关节不可能在室内关节上提出新的需求，该需求可能超过软骨的极限和结果 在次级OA中。大多数接受脚踝融合手术的患者在比对中具有术前畸形 值得注意的是，所有脚踝OA患者中有60％的患者具有差异 tibiotalar关节。最近，发现同侧下部联合采用“补偿性”外翻 大约一半的患有脚踝OA的患者中约有一半的对齐。相对的差异畸形 倾向于中和腿和后足的整体对准，使得在临床方面看起来正常 检查。不幸的是，尽管目前对踝关节融合的手术建议为 如何纠正tibiotalar关节的差异差异，他们对补偿性外翻没有压力 距离关节的比对。我们最近完成的R21项目的结果说明了外科医生的潜力 从策略上调整踝关节融合以控制术后运动，关节空间距离和一致性 室内关节，这反过来又可能是媒体次级OA。尽管如此，踝关节融合手术的特定作用 尚未在体内纵向评估山谷关节的形式和功能。我们的广泛目标是 确定踝关节融合后导致患者预后较低的机械和结构因素。 R01 本文提出的通过定量，纵向表征踝关节的影响来解决这一目标 室内关节内体体的形式和功能的融合手术。在这里，我们采用专注的机械外观 在分为两组（有和没有补偿性外翻的患者 距离关节的比对； n = 24组）。在我们的初步数据的指导下，我们假设患者 在术前的术前补偿比对，较大的风险可能会改变形式。 踝关节融合手术后24个月的功能关系和劣质结果。 AIM 1将量化如何 踝关节融合从纵向统计形状改变了室内关节的比对和形态 由重量计算机断层扫描构建的模型。 AIM 2将量化踝关节融合 使用二元，在步行，楼梯上升和楼梯下降期间，室内关节的体内运动学变化 荧光镜。 AIM 3将综合这些数据以识别和隔离室内术前对齐的作用 关节具有下关节形态，体内运动和患者结局。如果成功，这个项目将提供 对踝关节融合的影响的第一个也是唯一的机械理解。我们预计这些完成 AIMS还将为我们提供先决条件，以进行以后的介入研究，我们将在这里进行 评估手术时的外围补偿是否会产生更好的结果。