{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:37:38Z","timestamp":1787755058822,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,7,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ambulatory activity is reduced in patients with ankle arthritis. In this study, we measured step activity over time in 2 treatment groups and secondarily compared step activity with results of patient-reported outcome measures (PROMs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients who were treated with either ankle arthrodesis or ankle arthroplasty wore a step activity monitor preoperatively and at 6, 12, 24, and 36 months postoperatively. Changes from preoperative baseline in total steps per day and per-day metrics of low, medium, and high-activity step counts were measured in both treatment groups. Step activity was compared with each subject\u2019s PROM scores as reported on the Musculoskeletal Function Assessment (MFA) and the Short Form-36 (SF-36) physical function and bodily pain subscales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 3 activity levels, combined group high-activity step counts showed the greatest increase (mean of 278 steps [95% confidence interval (CI), 150 to 407 steps], a 46% improvement from preoperatively). At 6 months, the mean high-activity step improvement for the arthroplasty group was 194 steps compared with a mean decline of 44 steps for the arthrodesis group (mean 238-step difference [95% CI, \u221260 to 536 steps]). By 36 months postoperatively, the greater improvement in high-activity steps for the arthroplasty versus the arthrodesis group was no longer present. There were no significant pairwise differences in improvement based on surgical treatment method at any individual follow-up time point. For a within-patient increase of 1,000 total steps, there was a mean change in the MFA, SF-36 physical function, and SF-36 bodily pain scores of \u22121.8 (95% CI, \u22122.4 to \u22121.2), 3.8 (95% CI, 2.8 to 4.8), and 2.8 (95% CI, 1.8 to 3.9), respectively (p &lt; 0.0001 for all associations). There was no evidence that the association differed by study visit, or by study visit and surgical procedure interaction (p &gt; 0.10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Surgical treatment of ankle arthritis significantly improves ambulatory activity, with greater change occurring at high activity levels. Improvement may occur more quickly following arthroplasty than arthrodesis, but at 3 years, we detected no significant difference between the 2 procedures. Step counts, while associated with PROMs, do not parallel them, and thus may be a useful supplementary measure, particularly in longitudinal studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00511","type":"journal-article","created":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T18:31:10Z","timestamp":1562869870000},"page":"1177-1184","source":"Crossref","is-referenced-by-count":21,"title":["Step Activity After Surgical Treatment of Ankle Arthritis"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6354-2817","authenticated-orcid":false,"given":"Jane B.","family":"Shofer","sequence":"first","affiliation":[{"name":"RR&D Center, VA Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-7714","authenticated-orcid":false,"given":"William R.","family":"Ledoux","sequence":"additional","affiliation":[{"name":"RR&D Center, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Departments of Mechanical Engineering (W.R.L.) and Orthopaedics & Sports Medicine (W.R.L., S.T.H., and B.J.S.), University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-8201","authenticated-orcid":false,"given":"Michael S.","family":"Orendurff","sequence":"additional","affiliation":[{"name":"RR&D Center, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Motion & Sports Performance Laboratory, Stanford Children\u2019s Health, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7482-0728","authenticated-orcid":false,"given":"Sigvard T.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Departments of Mechanical Engineering (W.R.L.) and Orthopaedics & Sports Medicine (W.R.L., S.T.H., and B.J.S.), University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6309-5308","authenticated-orcid":false,"given":"James","family":"Davitt","sequence":"additional","affiliation":[{"name":"Orthopedic + Fracture Specialists, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7877-9972","authenticated-orcid":false,"given":"John G.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Orthopaedic Associates of Michigan, Grand Rapids, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6273-4833","authenticated-orcid":false,"given":"Donald","family":"Bohay","sequence":"additional","affiliation":[{"name":"Orthopaedic Associates of Michigan, Grand Rapids, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6822-9512","authenticated-orcid":false,"given":"J. Chris","family":"Coetzee","sequence":"additional","affiliation":[{"name":"Twin Cities Orthopedics, Edina, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-1334","authenticated-orcid":false,"given":"Michael","family":"Houghton","sequence":"additional","affiliation":[{"name":"Orthopaedic & Spine Center of the Rockies, Fort Collins, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4386-2677","authenticated-orcid":false,"given":"Daniel C.","family":"Norvell","sequence":"additional","affiliation":[{"name":"Spectrum Research, Tacoma, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4665-2579","authenticated-orcid":false,"given":"Bruce J.","family":"Sangeorzan","sequence":"additional","affiliation":[{"name":"RR&D Center, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Departments of Mechanical Engineering (W.R.L.) and Orthopaedics & Sports Medicine (W.R.L., S.T.H., and B.J.S.), University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"7","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/107110070502600707","article-title":"Functional limitations of patients with end-stage ankle arthrosis","volume":"26","author":"Agel","year":"2005","journal-title":"Foot Ankle Int."},{"issue":"9","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2106\/JBJS.K.01177","article-title":"Functional limitations associated with end-stage ankle arthritis","volume":"94","author":"Segal","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1177\/107110070502601112","article-title":"Reliability of the Foot Function Index: a report of the AOFAS Outcomes Committee","volume":"26","author":"Agel","year":"2005","journal-title":"Foot Ankle Int."},{"issue":"3","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"499","DOI":"10.2106\/JBJS.F.01299","article-title":"Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis","volume":"90","author":"Glazebrook","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3113\/FAI.2012.0282","article-title":"Comparative gait analysis of ankle arthrodesis and arthroplasty: initial findings of a prospective study","volume":"33","author":"Hahn","year":"2012","journal-title":"Foot Ankle Int."},{"issue":"8","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.clinbiomech.2007.05.003","article-title":"Gait analysis in ankle osteoarthritis and total ankle replacement","volume":"22","author":"Valderrabano","year":"2007","journal-title":"Clin Biomech (Bristol, Avon)."},{"issue":"10","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1177\/1071100713490675","article-title":"Comparison of gait after total ankle arthroplasty and ankle arthrodesis","volume":"34","author":"Flavin","year":"2013","journal-title":"Foot Ankle Int."},{"issue":"1","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3113\/FAI.2008.0003","article-title":"Ankle replacement versus arthrodesis: a comparative gait analysis study","volume":"29","author":"Piriou","year":"2008","journal-title":"Foot Ankle Int."},{"issue":"2","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2106\/JBJS.L.01597","article-title":"Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study","volume":"96","author":"Daniels","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"579","DOI":"10.3113\/FAI.2009.0579","article-title":"Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results","volume":"30","author":"Saltzman","year":"2009","journal-title":"Foot Ankle Int."},{"issue":"21","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.2106\/JBJS.16.01471","article-title":"Comparison of treatment outcomes of arthrodesis and two generations of ankle replacement implants","volume":"99","author":"Benich","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1007\/s00264-011-1455-8","article-title":"Total ankle arthroplasty versus ankle arthrodesis. 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