Skip to main content
SpringerLink
Log in

Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The stress distribution of an ankle under various physiological conditions is important for long-term survival of total ankle arthroplasty. The aim of this study was to measure subchondral bone density across the distal tibial joint surface in patients with malalignment/instability of the lower limb.

Methods

We evaluated subchondral bone density across the distal tibial joint in patients with malalignment/instability of the knee by computed tomography (CT) osteoabsorptiometry from ten ankles as controls and from 27 ankles with varus deformity/instability of the knee. The quantitative analysis focused on the location of the high-density area at the articular surface, to determine the resultant long-term stress on the ankle joint.

Results

The area of maximum density of subchondral bone was located in the medial part in all subjects. The pattern of maximum density in the anterolateral area showed stepwise increases with the development of varus deformity/instability of the knee.

Conclusions

Our results should prove helpful for designing new prostheses and determining clinical indications for total ankle arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tallroth K, Harilainen A, Kerttula L, Sayed R (2008) Ankle osteoarthritis is associated with knee osteoarthritis. Conclusions based on mechanical axis radiographs. Arch Orthop Trauma Surg 128(6):555–560. doi:10.1007/s00402-007-0502-9

    Article  PubMed  Google Scholar 

  2. Merchant TC, Dietz FR (1989) Long-term follow-up after fractures of the tibial and fibular shafts. J Bone Joint Surg Am 71(4):599–606

    PubMed  CAS  Google Scholar 

  3. van der Schoot DK, Den Outer AJ, Bode PJ, Obermann WR, van Vugt AB (1996) Degenerative changes at the knee and ankle related to malunion of tibial fractures. 15-year follow-up of 88 patients. J Bone Joint Surg Br 78(5):722–725

    PubMed  Google Scholar 

  4. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46

    PubMed  Google Scholar 

  5. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806. doi:10.1007/s11999-008-0543-6

    Article  PubMed  Google Scholar 

  6. Günther KP, Stürmer T, Sauerland S, Zeissig I, Sun Y, Kessler S, Scharf HP, Brenner H, Puhl W (1998) Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis 57(12):717–723

    Article  PubMed  Google Scholar 

  7. Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ (2000) Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res 18(5):739–748. doi:10.1002/jor.1100180510

    Article  PubMed  CAS  Google Scholar 

  8. Gougoulias N, Khanna A, Maffulli N (2010) How successful are current ankle replacements?: a systematic review of the literature. Clin Orthop Relat Res 468(1):199–208. doi:10.1007/s11999-009-0987-3

    Article  PubMed  Google Scholar 

  9. Stengel D, Bauwens K, Ekkernkamp A, Cramer J (2005) Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis. Arch Orthop Trauma Surg 125(2):109–119. doi:10.1007/s00402-004-0765-3

    Article  PubMed  Google Scholar 

  10. Doets HC, Brand R, Nelissen RG (2006) Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am 88(6):1272–1284. doi:10.2106/JBJS.E.00414

    Article  PubMed  Google Scholar 

  11. Wood PL, Sutton C, Mishra V, Suneja R (2009) A randomised, controlled trial of two mobile-bearing total ankle replacements. J Bone Joint Surg Br 91(1):69–74. doi:10.1302/0301-620X.91B1.21346

    Article  PubMed  CAS  Google Scholar 

  12. Koepp H, Eger W, Muehleman C, Valdellon A, Buckwalter JA, Kuettner KE, Cole AA (1999) Prevalence of articular cartilage degeneration in the ankle and knee joints of human organ donors. J Orthop Sci 4(6):407–412

    Article  PubMed  CAS  Google Scholar 

  13. Muehleman C, Margulis A, Bae WC, Masuda K (2010) Relationship between knee and ankle degeneration in a population of organ donors. BMC Med 8:48. doi:10.1186/1741-7015-8-48

    Article  PubMed  Google Scholar 

  14. Li G, Wan L, Kozanek M (2008) Determination of real-time in-vivo cartilage contact deformation in the ankle joint. J Biomech 41(1):128–136. doi:10.1016/j.jbiomech.2007.07.006

    Article  PubMed  CAS  Google Scholar 

  15. Wan L, de Asla RJ, Rubash HE, Li G (2006) Determination of in-vivo articular cartilage contact areas of human talocrural joint under weightbearing conditions. Osteoarthritis Cartilage 14(12):1294–1301. doi:10.1016/j.joca.2006.05.012

    Article  PubMed  CAS  Google Scholar 

  16. Müller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B (1989) Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints. Skeletal Radiol 18(7):507–512

    Article  PubMed  Google Scholar 

  17. Müller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B (1990) Demonstration of subchondral density pattern using CT-osteoabsorptiometry (CT-OAM) for the assessment of individual joint stress in live patients. Z Orthop Ihre Grenzgeb 128(2):128–133. doi:10.1055/s-2008-1039487

    Article  PubMed  Google Scholar 

  18. Eckstein F, Löhe F, Müller-Gerbl M, Steinlechner M, Putz R (1994) Stress distribution in the trochlear notch. A model of bicentric load transmission through joints. J Bone Joint Surg Br 76(4):647–653

    PubMed  CAS  Google Scholar 

  19. Eckstein F, Müller-Gerbl M, Steinlechner M, Kierse R, Putz R (1995) Subchondral bone density in the human elbow assessed by computed tomography osteoabsorptiometry: a reflection of the loading history of the joint surfaces. J Orthop Res 13(2):268–278. doi:10.1002/jor.1100130215

    Article  PubMed  CAS  Google Scholar 

  20. Iwasaki N, Minami A, Miyazawa T, Kaneda K (2000) Force distribution through the wrist joint in patients with different stages of Kienböck’s disease: using computed tomography osteoabsorptiometry. J Hand Surg Am 25(5):870–876. doi:10.1053/jhsu.2000.16353

    Article  PubMed  CAS  Google Scholar 

  21. Müller-Gerbl M, Weisser S, Linsenmeier U (2008) The distribution of mineral density in the cervical vertebral endplates. Eur Spine J 17(3):432–438. doi:10.1007/s00586-008-0601-5

    Article  PubMed  Google Scholar 

  22. Oizumi N, Suenaga N, Minami A, Iwasaki N, Miyazawa T (2003) Stress distribution patterns at the coracoacromial arch in rotator cuff tear measured by computed tomography osteoabsorptiometry. J Orthop Res 21(3):393–398. doi:10.1016/S0736-0266(02)00231-0

    Article  PubMed  Google Scholar 

  23. Makabe H, Iwasaki N, Kamishima T, Oizumi N, Tadano S, Minami A (2011) Computed tomography osteoabsorptiometry alterations in stress distribution patterns through the wrist after radial shortening osteotomy for Kienböck disease. J Hand Surg Am 36(7):1158-1164. doi: 10.1016/j.jhsa.2011.04.001

    Article  PubMed  Google Scholar 

  24. Momma D, Iwasaki N, Oizumi N, Nakatsuchi H, Funakoshi T, Kamishima T, Tadano S, Minami A (2011) Long-term stress distribution patterns across the elbow joint in baseball players assessed by computed tomography osteoabsorptiometry. Am J Sports Med 39(2):336–341. doi:10.1177/0363546510383487

    Article  PubMed  Google Scholar 

  25. Ogata K, Yasunaga M, Nomiyama H (1997) The effect of wedged insoles on the thrust of osteoarthritic knees. Int Orthop 21(5):308–312

    Article  PubMed  CAS  Google Scholar 

  26. Scott WN (2006) Examination of the knee. In: Insall and Scott surgery of the knee, 4th edn. Churchill Livingstone Elsevier, Philadelphia

    Google Scholar 

  27. Christensen JC, Driscoll HL, Tencer AF (1994) 1994 William J. Stickel Gold Award. Contact characteristics of the ankle joint. Part 2. The effects of talar dome cartilage defects. J Am Podiatr Med Assoc 84(11):537–547

    PubMed  CAS  Google Scholar 

  28. Driscoll HL, Christensen JC, Tencer AF (1994) Contact characteristics of the ankle joint. Part 1. The normal joint. J Am Podiatr Med Assoc 84(10):491–498

    PubMed  CAS  Google Scholar 

  29. Michelson JD, Checcone M, Kuhn T, Varner K (2001) Intra-articular load distribution in the human ankle joint during motion. Foot Ankle Int 22(3):226–233

    PubMed  CAS  Google Scholar 

  30. Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58(3):356–357

    PubMed  CAS  Google Scholar 

  31. Steffensmeier SJ, Saltzman CL, Berbaum KS, Brown TD (1996) Effects of medial and lateral displacement calcaneal osteotomies on tibiotalar joint contact stresses. J Orthop Res 14(6):980–985. doi:10.1002/jor.1100140619

    Article  PubMed  CAS  Google Scholar 

  32. Wagner KS, Tarr RR, Resnick C, Sarmiento A (1984) The effect of simulated tibial deformities on the ankle joint during the gait cycle. Foot Ankle 5(3):131–141

    PubMed  CAS  Google Scholar 

  33. Anderson DD, Goldsworthy JK, Li W, James Rudert M, Tochigi Y, Brown TD (2007) Physical validation of a patient-specific contact finite element model of the ankle. J Biomech 40(8):1662–1669. doi:10.1016/j.jbiomech.2007.01.024

    Article  PubMed  Google Scholar 

  34. Reggiani B, Leardini A, Corazza F, Taylor M (2006) Finite element analysis of a total ankle replacement during the stance phase of gait. J Biomech 39(8):1435–1443. doi:10.1016/j.jbiomech.2005.04.010

    Article  PubMed  CAS  Google Scholar 

  35. Buckwalter JA, Saltzman CL (1999) Ankle osteoarthritis: distinctive characteristics. Instr Course Lect 48:233–241

    PubMed  CAS  Google Scholar 

  36. Huch K, Kuettner KE, Dieppe P (1997) Osteoarthritis in ankle and knee joints. Semin Arthritis Rheum 26(4):667–674

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Tomohiro Onodera, Norimasa Iwasaki, Yasuhiko Kasahara & Akio Minami

  2. Department of Joint Replacement and Tissue Engineering, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Tokifumi Majima

  3. Department of Biomedical Science and Engineering, Hokkaido University Hospital, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Tamotsu Kamishima

Authors
  1. Tomohiro Onodera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tokifumi Majima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norimasa Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tamotsu Kamishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasuhiko Kasahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akio Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomohiro Onodera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Onodera, T., Majima, T., Iwasaki, N. et al. Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry. International Orthopaedics (SICOT) 36, 1871–1876 (2012). https://doi.org/10.1007/s00264-012-1607-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-012-1607-5

Keywords

Search

Navigation