Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement

Carlos De la Fuente, Eduardo Martinez-Valdes, Carlos Cruz-Montecinos, Rodrigo Guzman-Venegas, David Arriagada, Roberto Peña y Lillo, Hugo Henríquez, Felipe P. Carpes*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: The Hintegra® arthroplasty provides inversion-eversion stability, permits axial rotation, ankle flexion-extension, and improvements of the gait patterns are expected up to 12 months of rehabilitation. However, sensorimotor impairments are observed in ankle flexors/extensors muscles after rehabilitation, with potential negative effects on locomotion. Here we determined the timing and amplitude of co-activation of the tibialis anterior and medial gastrocnemius muscles during gait by assessing non-operated and operated legs of patients with total ankle replacement, 5 years after surgery. Methods: Twenty-nine patients (age: 58 [5.5] years, height: 156.4 [6.5] cm, body mass: 72.9 [6.5] kg, 10 men, and 19 women) that underwent Hintegra® ankle arthroplasty were included. Inclusion criteria included 5 years prosthesis survivorship. The onset and offset of muscle activation (timing), as well as the amplitude of activation, were determined during barefoot walking at self-selected speed by surface electromyography. The timing, percentage, and index of co-activation between the tibialis anterior and medial gastrocnemius were quantified and compared between non-operated and operated legs. Findings: The operated leg showed higher co-activation index and temporal overlapping between tibialis anterior and medial gastrocnemius during gait (p < 0.001). Interpretation: The neuromuscular changes developed during the process of degeneration do not appear to be restored 5 years following arthroplasty. The insertion of an ankle implant may restore anatomy and alignment but neuromuscular adaptations to degeneration are not corrected by 5 years following joint replacement.

Original languageEnglish
Pages (from-to)130-135
Number of pages6
JournalClinical Biomechanics
StatePublished - Nov 2018

Bibliographical note

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. FPC is supported by a CNPq research fellowship.

Publisher Copyright:
© 2018 Elsevier Ltd


  • EMG
  • Gastrocnemius
  • Joint stiffness
  • Tibialis anterior
  • Total ankle replacement
  • Walking


Dive into the research topics of 'Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement'. Together they form a unique fingerprint.

Cite this