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What You Need To Know About Total Ankle Replacement

By John M. Sigle, DPM, FACFAS, Foot & Ankle Center of Illinois

Fusion of the ankle joint has been the gold standard procedure for end stage ankle arthritis in modern medicine. It takes away the pain of the arthritis but leaves the ankle stiff and awkward to walk on. It often leads to unsatisfied patients. During the early 80s, total ankle replacement hit the market. There was optimism that ankle replacements would become as successful as hip and knee replacements but they were rarely performed during the 1980s because of high failure rates. Early ankle replacement designs were not stable in the long run. There are three new designs that are FDA approved and have had ten year survival rates comparable to total knee replacements. Total ankle replacement made a strong comeback because of the success patients and physicians are having. Patient satisfaction and quality of life are much higher than that of ankle fusion. Total ankle replacement is especially becoming a viable option for baby boomers that suffer from debilitating ankle arthritis pain and injury and want to remain active. Here are some of the more frequently asked questions I get from my patients and brief explanations:

Who Should Have Ankle Replacement?
The person who needs an ankle replacement has pain from arthritis. That person either has a disease like Osteoarthritis, Rheumatoid Arthritis, Post Traumatic Arthritis following an injury or fracture, or their ankle has just worn out. Patients are typically over the age of 50, healthy, and moderately active.

Who is Not an Ideal Candidate for Ankle Replacement?
Not every patient is a good candidate for ankle replacement, especially patients with unstable ankles or severe deformities. Advanced age, being overweight, and other medical conditions causing neuropathy may also make you less likely to be a good candidate for ankle replacement.

What is Ankle Replacement?
Ankle Replacement involves the removal of a damaged joint and replacement with an artificial joint (prosthesis) made of metal and plastic to reduce pain and to improve function.

What are the Benefits of Ankle Replacement?
Patients are excited about the results they are achieving because pain relief allows them to retain motion. Patients are able to retain the integrity and shape of their calf muscle and to participate in activities such as walking, biking, exercises, golf, and swimming.

What Types of Ankle Replacement Devices are Available?
To learn about the various device,s consult with your physician and visit the supplier websites. Here is a list of devices:

  • The Inbone Total Ankle (produced by Wright Technology and FDA approved in 2005) consists of a tibial and a talar component, and a high-strength polyethylene piece secured within a titanium holder.
  • The Salto Talaris Anatomic Ankle (FDA approved in 2006), provides the anatomy and flexion/extension movements similar to a natural ankle joint.
  • The STAR (FDA approved in 2009), is the first three-component, mobile bearing ankle marketed in the U.S.


Other Options to Surgery and Ankle Replacement
Ankle arthritis can be addressed by other non-surgical means besides total ankle replacement such as physical therapy, injections, and brace treatment. Other surgical options to consider include arthroscopic or open debridement to clean up a joint or remove bone spurs, distraction arthroplasty (a cleanup procedure as well as stretching the joint apart with an external fixation device), and osteotomies or bone cuts to move a bone in the right position.

What are the Risks?
There are rare to slight risks of infection, damage to blood vessels, blood clots in legs and lungs, and fracture of the bones at the ankle joint. The most common complications are wound healing problems, nerve injury, and component malposition. Loosening of the ankle joint occurs in roughly 10 percent of the cases over a 10-year time frame.

What Can You Expect After Ankle Replacement?
Treatment offers promise of restored mobility, improved function, and reduced pain. It will be easier to walk further without a walking aid and to return to non-impact recreational activities. Roughly 97 percent of replaced ankle joints are working very well after three years and 90 percent are working well after 10 years in the most recent peer reviewed literature. Quality of life is likely to improve substantially because of this treatment.

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 Foot & Ankle Center of Illinois| August 01, 2012
Keywords:  SHC

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