Total Ankle Replacements Stepping Ahead of Ankle Fusions

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

New technological advancements in ankle implants and high patient satisfaction are the primary reasons total ankle replacement (arthroplasty) is on the rise. According to the American College of Foot and Ankle Surgeons, ankle replacements have doubled in the past year. Many medical practitioners believe that there will be fewer fusions and more ankle replacements in the future. This is particularly great news for people who are looking for an alternative to ankle fusion (arthrodesis) that takes away the pain but leaves the ankle immobile. Ankle fusion has been the gold standard procedure for end-stage ankle arthritis for some time and continues to be a very viable option; however, ankle replacement is becoming the treatment of choice, especially for baby boomers who want to continue their active lifestyles. Here are some of the more common questions and responses about ankle replacement.

Who are the Best Candidates for Ankle Replacement?
The best candidates for ankle replacement are typically suffering from osteoarthritis (degenerative arthritis) due to the wear and tear of the gliding surface over the end of the bones, or post-traumatic arthritis resulting from an injury that damages the cartilage. The best candidates are older than 50, healthy, less active, and less likely to subject the prosthesis to excessive demands from recreation or work activities.

What are the Contraindications?
Not all patients are good candidates for ankle replacement. Replacement may be contraindicated for people who are overweight or obese, or if a person has a severe ankle deformity that affects alignment or stability. People diagnosed with a peripheral vascular disease, neuropathy, or osteoporosis are not good candidates. Replacements are also not advised for younger candidates with active lifestyles, and people with physically demanding occupations.

How is Ankle Replacement Performed?
The surgical procedures vary depending on the type of prosthesis used. Basically, ankle replacement involves the removal of a damaged joint, reshaping the tibia (shin bone), fibula (lower leg bone), and talus (foot bone), and readapting the area for the attachment of the artificial joint (prosthesis). This is performed with precise instruments to create a level surface for the implanted prosthesis. The metal and plastic implants are then placed into the bone ends to function as a new ankle. Surgery is done while the patient is under anesthesia or spinal anesthesia. Surgery usually takes two hours to perform.

What is the Length of Recovery?
Patients spend the night in the hospital and are discharged the next day. Patients must use a walker or crutches for several weeks to relieve the ankle from pressure. It usually takes three months for complete recovery.

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, component malposition, and persistent pain. Achieving proper alignment of the implants is difficult and cannot always be achieved. If results are not satisfactory, the joint may have to be removed requiring ankle fusion.

What Can You Expect After Ankle Replacement?
Treatment offers restored mobility, improved flexibility and function, and reduced pain. It will be easier to walk further without a walking aid. Patients are also able to retain the integrity and shape of their calf muscle and to participate in activities such as walking, biking, moderate exercises, golf, and swimming. 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 substantially improve because of this treatment.
What Types of Ankle Replacement Devices are Available?
Consult with your physician and visit the supplier websites to learn more about the devices. Here are the most common ones that are FDA approved:

• 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 (produced by Tornier, Inc. and FDA approved in 2006) provides the anatomy and flexion/extension movements similar to a natural ankle joint.
• The STAR (produced by Small Bone Innovations, Inc. and FDA approved in 2009) is the first three-component, mobile bearing ankle marketed in the US.

How Do I Get a Diagnosis and More Information?
As with all complicated foot and ankle disorders, consult with your orthopaedic or podiatric surgeon to determine if you are a good candidate for ankle replacement. Because of the complexity of the procedure, select a surgeon who has advanced residency/fellowship training in foot and ankle surgery, is board-certified in reconstructive rear foot/ankle surgery, certified by the medical supplier, and has a demonstrated track record of success.

If you suffer from chronic, unexplained foot pain and you want a definitive diagnosis, call Dr. Sigle today at 217-787-2700 for an appointment. Dr. Sigle can be seen at the Foot & Ankle Center of Illinois in Springfield, Illinois, and at St. Mary’s Hospital in Decatur, Illinois. To learn more about arthritis and ankle replacement, visit www.myfootandanklecenter.com.