International Orthopaedics

, Volume 36, Issue 3, pp 571–578 | Cite as

Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint

  • Francesco CenniEmail author
  • Alberto Leardini
  • Andrea Cheli
  • Fabio Catani
  • Claudio Belvedere
  • Matteo Romagnoli
  • Sandro Giannini
Original Paper



In some cases of total ankle replacement, perfect alignment of the prosthetic components is not achieved. This study analyses the extent to which component positioning is critical for the final range of motion.


Fourteen patients undergoing total ankle replacement were assessed preoperatively and postoperatively at seven and 13 months follow-up. X-ray pictures of the ankle were taken in static double leg stance, i.e. at neutral joint position, and in maximum plantarflexion and dorsiflexion. Measurements were obtained by a specially devised computer program based on anatomical reference points digitised on the radiograms. These allowed calculation of the position and orientation of the components in the sagittal and coronal planes, together with the joint range of motion.


The mean range of motion was about 34 degrees at the first follow-up and maintained at the second. Tibial and talar components were more anterior than the mid-tibial shaft in 11 and nine patients, respectively. Mean inclination was about four degrees posterior for the tibial component and nearly one degree anterior for the talar component. A significantly larger range of motion was found in ankles both with the talar component located and inclined more anteriorly than the tibial.


Correlation, though weak, was found between motion at the replaced ankle and possible residual subluxation and inclination of the components. However, a satisfactory range of motion was also achieved in those patients where recommended locations for the components could not be reached because of the size of the original joint deformity.


Tibial Component Prosthetic Component Total Ankle Replacement AOFAS Score Talar Component 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank John J. O’Connor for the invaluable and useful discussions on the manuscript.

Conflict of interest

The Istituto Ortopedico Rizzoli has a licence agreement with the company producing the prosthesis, under which it receives royalties. However, the study was performed on a voluntary basis, and the company was not involved in any of the phases, i.e. planning of the experiment, collection or analyses or interpretation of the data, and writing of the manuscript.


  1. 1.
    Banks SA, Hodge WA (1996) Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng 43:638–649PubMedCrossRefGoogle Scholar
  2. 2.
    Besse JL, Brito N, Lienhart C (2009) Clinical evaluation and radiographic assessment of bone lysis of the AES total ankle replacement. Foot Ankle Int 30:964–975PubMedCrossRefGoogle Scholar
  3. 3.
    Brage ME, Bennett CR, Whitehurst JB, Getty PJ, Toledano A (1997) Observer reliability in ankle radiographic measurements. Foot Ankle Int 18:324–329PubMedGoogle Scholar
  4. 4.
    Coetzee JC, Castro MD (2004) Accurate measurement of ankle range of motion after total ankle arthroplasty. Clin Orthop Relat Res 424:27–31PubMedCrossRefGoogle Scholar
  5. 5.
    Conti SF, Wong YS (2001) Complications of total ankle replacement. Clin Orthop Relat Res 391:105–114PubMedCrossRefGoogle Scholar
  6. 6.
    Cracchiolo A III, DeOrio JK (2008) Design features of current total ankle replacements: implants and instrumentation. J Am Acad Orthop Surg 16:530–540PubMedGoogle Scholar
  7. 7.
    Doets C, Brand R, Nelissen R (2006) Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am 88:1272–1284PubMedCrossRefGoogle Scholar
  8. 8.
    Doets HC, van Middelkoop M, Houdijk H, Nelissen RG, Veeger HE (2007) Gait analysis after successful mobile bearing total ankle replacement. Foot Ankle Int 28:313–322, Erratum in: Foot Ankle Int May;28(5):viPubMedCrossRefGoogle Scholar
  9. 9.
    Espinosa N, Walti M, Favre P, Snedeker JG (2010) Misalignment of total ankle components can induce high joint contact pressures. J Bone Joint Surg Am 92:1179–1187PubMedCrossRefGoogle Scholar
  10. 10.
    Giannini S, Romagnoli M, O’Connor JJ, Malerba F, Leardini A (2010) Total ankle replacement compatible with ligament function produces mobility, good clinical scores, and low complication rates. Clin Orthop Relat Res 468:2746–2753PubMedCrossRefGoogle Scholar
  11. 11.
    Gill LH (2004) Challenges in total ankle arthroplasty. Foot Ankle Int 25:195–207PubMedGoogle Scholar
  12. 12.
    Gougoulias N, Khanna A, Maffulli N (2010) How successful are current ankle replacements? A systematic review of the literature. Clin Orthop Relat Res 468:199–208PubMedCrossRefGoogle Scholar
  13. 13.
    Grood E, Suntay W (1983) A joint coordinate system for the clinical description of three- dimensional motions: application to the knee. J Biomech Eng 105:136–144PubMedCrossRefGoogle Scholar
  14. 14.
    Guyer AJ, Richardson G (2008) Current concepts review: total ankle arthroplasty. Foot Ankle Int 29:256–264PubMedCrossRefGoogle Scholar
  15. 15.
    Haddad SL, Coetzee JC, Estok R et al (2007) Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis: a systematic review of the literature. J Bone Joint Surg [Am] 89-A:1899–1905CrossRefGoogle Scholar
  16. 16.
    Haskell A, Mann RA (2004) Ankle arthroplasty with preoperative coronal plane deformity: short term results. Clin Orthop Relat Res 424:98–103PubMedCrossRefGoogle Scholar
  17. 17.
    Hobson SA, Karantana A, Dhar S (2009) Total ankle replacement in patients with significant pre-operative deformity of the hindfoot. J Bone Joint Surg Br 91-B:481–486CrossRefGoogle Scholar
  18. 18.
    Ingrosso S, Benedetti MG, Leardini et al (2009) Gait analysis in patients operated with a novel total ankle prosthesis. Gait Posture 30:132–137PubMedCrossRefGoogle Scholar
  19. 19.
    Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMedGoogle Scholar
  20. 20.
    Leardini A, Catani F, Giannini S, O’Connor JJ (2001) Computer-assisted design of the sagittal shapes for a novel total ankle replacement. Med Biol Eng Comp 39:168–175CrossRefGoogle Scholar
  21. 21.
    Leardini A, Chiari L, Della Croce U, Cappozzo A (2005) Human movement analysis using stereophotogrammetry Part 3. Soft tissue artefact assessment and compensation. Gait Posture 21:212–225PubMedCrossRefGoogle Scholar
  22. 22.
    Leardini A, O’Connor JJ, Catani F, Giannini S (2004) Mobility of the human ankle and the design of total ankle replacement. Clin Orthop Relat Res 424:39–46PubMedCrossRefGoogle Scholar
  23. 23.
    Leardini A, O’Connor JJ, Catani F, Giannini S (1999) A geometric model of the human ankle joint. J Biomech 32:585–591PubMedCrossRefGoogle Scholar
  24. 24.
    Leszko F, Komistek RD, Mahfouz MR et al (2008) In vivo kinematics of the Salto total ankle prosthesis. Foot Ankle Int 29:1117–1125PubMedCrossRefGoogle Scholar
  25. 25.
    Pyevich MT, Saltzman CL, Callaghan JJ, Alvine FG (1998) Total ankle arthroplasty: a unique design. Two to twelve-year follow-up. J Bone Joint Surg Am 80:1410–1420PubMedGoogle Scholar
  26. 26.
    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 39:1435–1443PubMedCrossRefGoogle Scholar
  27. 27.
    Saltzman CL, Tochigi Y, Rudert MJ, McIff TE, Brown TD (2004) The effect of agility ankle prosthesis misalignment on the peri-ankle ligaments. Clin Orthop Relat Res 424:137–142PubMedCrossRefGoogle Scholar
  28. 28.
    Stagni R, Leardini A, Catani F, Cappello A (2004) A new semiautomated measurement technique based on X-ray pictures for ankle morphometry. J Biomech 37:1113–1118PubMedCrossRefGoogle Scholar
  29. 29.
    Stagni R, Leardini A, Ensini A, Cappello A (2005) Ankle morphometry evaluated using a new semi-automated technique based on X-ray pictures. Clin Biomech 20:307–311CrossRefGoogle Scholar
  30. 30.
    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 125:109–119PubMedCrossRefGoogle Scholar
  31. 31.
    Tochigi Y, Rudert MJ, Brown TD, McIff E, Saltzman CL (2005) The effect of accuracy of implantation on range of movement of the Scandinavian total ankle replacement. J Bone Joint Surg Br 87-B:736–740CrossRefGoogle Scholar
  32. 32.
    Tochigi Y, Suh JS, Amendola A, Saltzman CL (2006) Ankle alignment on lateral radiographs. Part 2: reliability and validity of measures. Foot Ankle Int 27:88–92PubMedGoogle Scholar
  33. 33.
    Watanabe K, Crevoisier XM, Kitaoka HB, Zhao KD, Berglund LJ, Kaufman KR, An KN (2009) Analysis of joint laxity after total ankle arthroplasty: cadaver study. Clin Biomech 24:655–660CrossRefGoogle Scholar
  34. 34.
    Wood PLR, Prem H, Sutton C (2008) Total ankle replacement. Medium term results in 200 Scandinavian total ankle replacements. J Bone Joint Surg Br 90:605–609PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Francesco Cenni
    • 1
    Email author
  • Alberto Leardini
    • 1
  • Andrea Cheli
    • 1
  • Fabio Catani
    • 2
  • Claudio Belvedere
    • 1
  • Matteo Romagnoli
    • 3
  • Sandro Giannini
    • 1
    • 3
  1. 1.Movement Analysis LaboratoryIstituto Ortopedico RizzoliBolognaItaly
  2. 2.Orthopaedic and Trauma DepartmentPoliclinico di ModenaModenaItaly
  3. 3.Department of Orthopaedic SurgeryIstituto Ortopedico RizzoliBolognaItaly

Personalised recommendations