Methodology for Comparing Joint Level Measurements and Morphometric Shape Following Tibiotalar Arthrodesis and Total Ankle Replacement

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Abstract

Tibiotalar arthrodesis and total ankle replacement (TAR) are the current standards for treatment of end-stage ankle osteoarthritis (OA). Our clinical understanding of the biomechanical causes and risk factors for subtalar secondary OA development following surgical treatment is limited. Dynamic joint level measurements can be investigated in combination with morphology analyses to investigate the form and function relationship of the subtalar joint. The objective of this thesis was to develop a methodology to investigate joint level morphological differences that may influence subtalar joint measurements following tibiotalar arthrodesis and total ankle replacement compared to asymptomatic healthy controls.

Our prior work included calculated in vivo bone kinematics using biplane fluoroscopy in individuals with unilateral TAR or tibiotalar arthrodesis, and healthy controls during an overground walking task. A calcaneus statistical shape model (SSM) was created of the study population. Correspondence particles from the SSM were used to compare joint level measurements across the different groups. During each timepoint of gait, joint space distance and congruence index between matched surfaces of the calcaneus and talus were calculated and paired to correspondence particles; these were statistically compared using a temporal statistical parametric mapping analysis. Additionally, from SSM, morphological differences were quantified and characterized using a linear discriminate model to characterize the cohorts.

Minimal statistical significance for congruence index was found when comparing patient groups to healthy controls. However, tibiotalar arthrodesis participants showed an increased joint space distance in the anteromedial facet during early stance that was statistically significant when compared to healthy controls. From the linear discriminant model, the TAR group was closer in shape scores to arthrodesis than healthy controls. Patient groups showed decreased height of the anteromedial facet, including flattening and widening of the posterior facet.

In vivo kinematics combined with SSM provide valuable information concerning the interplay between bone morphology and joint level measurements in patients treated for end-stage ankle OA. We created a methodology to compare measurements of joint morphology. This thesis highlights the complexity of the subtalar joint, the value of robust 3D analyses, and the necessity to further investigate interactions of subtalar function and morphology to clinically evaluate subtalar OA.

Cited Works (9)

Year	Entry
1992	Ateshian GA, Rosenwasser MP, Mow VC. Curvature characteristics and congruence of the thumb carpometacarpal joint: differences between female and male joints. J Biomech. June 1992;25(6):591-607.
2014	Kapron AL, Aoki SK, Peters CL, Maas SA, Bey MJ, Zauel R, Anderson AE. Accuracy and feasibility of dual fluoroscopy and model-based tracking to quantify in vivo hip kinematics during clinical exams. J Appl Biomech. June 2014;30(3):461-470.
2006	Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng. August 2006;128(4):604-609.
2011	Guilak F. Biomechanical factors in osteoarthritis. Best Pract Res Clin Rheumatol. December 2011;25(6):815-823.
2002	Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion, I: ankle, hip, and spine. J Biomech. 2002;35(4):543-548.
1999	Shepherd DET, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. January 1999;58(1):27-34.
2015	Pataky TC, Vanrenterghem J, Robinson MA. Zero- vs. one-dimensional, parametric vs. non-parametric, and confidence interval vs. hypothesis testing procedures in one-dimensional biomechanical trajectory analysis. J Biomech. May 1, 2015;48(7):1277-1285.
1992	Besl PJ, McKay ND. A method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell. February 1992;14(2):239-256.
2010	Pataky TC. Generalized n-dimensional biomechanical field analysis using statistical parametric mapping. J Biomech. July 20, 2010;43(10):1976-1982.