Change in gait biomechanics after total ankle replacement and ankle arthrodesis: a systematic review and meta-analysis

Clin Biomech (Bristol, Avon). 2020 Mar:73:213-225. doi: 10.1016/j.clinbiomech.2020.01.015. Epub 2020 Jan 20.


Background: The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis.

Methods: Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status.

Findings: Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis.

Interpretation: The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.

Keywords: Ankle replacement; Arthrodesis; Arthroplasty; Biomechanics; Gait analysis; Osteoarthritis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Ankle / surgery
  • Arthrodesis*
  • Arthroplasty, Replacement, Ankle*
  • Biomechanical Phenomena / physiology
  • Gait / physiology*
  • Humans
  • Osteoarthritis / surgery
  • Range of Motion, Articular / physiology*
  • Walking Speed