Ankle fusion has for many years been the standard treatment for severe ankle arthritis pain. Now, implant design improvements are having growing numbers of orthopedic surgeons and their patients considering ankle replacement.
Arthritis may sometimes cause awful pain which makes activities of daily living difficult, if not impossible. Although most are familiar with knee and hip replacement surgery for debilitating arthritis, ankle replacement is relatively uncommon.
“In ankle replacement, we replace the damaged surfaces of the ankle joint with an artificial implant,” says Dr. Jonathan Deland, MD, co-chief of the Foot and Ankle Service at Hospital for Special Surgery in New York City. “One of main the advantages of ankle replacement is that it provides patients with better movement and mobility compared to ankle fusion, in which bones in the ankle are fused together using metal screws.”
Ankle stiffness because of fusion puts also stress on other joints in the foot, leaving patients more prone to arthritis in those joints.
Advanced Ankle Implants
Dr. Deland helped design the latest implant used in ankle replacement. It is considered by many to be an advance over previous models.
“It is designed to better reproduce the ankle’s natural motion. It is also designed to be longer lasting. It has the proper curvatures like a normal ankle,” Dr. Deland said.
The surgical technique used with the new prosthesis involves an incision on the side of the ankle, as opposed to one in the front used for traditional implants.
“The side incision will generally cause less disruption to the soft tissues surrounding the ankle joint and allows for the replication of curved bone surfaces like those in a normal ankle,” Dr. Deland says.
Ankle Replacement Candidates
Good candidates for ankle replacement are those with severe pain, who conservative treatments, such as rest, pain medication and bracing, do not provide relief for. Eligible patients are at least 50 years old, they must have good bone quality and foot alignment, and they cannot have any underlying health problems that would impede healing, according to Dr. Deland.
In considering ankle replacement, Dr. Deland stresses the importance of choosing an orthopedic surgeon having considerable experience.
“No surgeon should do only one or two of these procedures per year — they’ll get into trouble mighty fast,” he says. “You have to know about foot alignment, and you have to know the implant. Studies show a steep learning curve when performing total ankle replacements.”
The surgery is covered by Medicare and major insurance companies.
Image by Maegan Tintari, Creative Commons 2.0 License