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The ankle joint which is very important for normal walking, fortunately is resistant to forming arthritis. However, if the ankle has suffered injuries, advanced arthritis can set in over time. For those patients with end-stage arthritis of the ankle (limitation of motion and/or worn out joint surfaces) there are relatively few treatment options outside of surgery. For some patients with end-stage ankle arthritis , ankle joint replacement is a viable option.
The era of ankle replacement began in the 1970's, when a doctor tried to replace the ankle with an upside down total hip replacement. Shortly thereafter there were many attempts at developing a reliable total ankle replacement. Almost all of the early total ankle replacements failed for various reasons including: poor methods for attaching the implant to bone, inaccurate placement, and poor match to the normal joint mechanics. Second generation implants were developed in the late 1980's and early 1990's. Over the past 25 years the instrumentation has improved, the implant materials and engineering have been refined, and reconstructive ankle surgeons are now considering the procedure a true alternative to joint fusion in some patients.
Today, the clinical outcomes of ankle replacement are very good and are more predictable. In terms of function, the ankle replacement is better than an ankle fusion. This is because the ankle, when it is fused, limits up and down motion of the foot on the leg. Whereas the ankle replacementpreserves motion at the ankle and allows improved function. The motion of the ankle implant also provides a protective function for the remaining joints in the foot, which can develop arthritis due to increased stress of a fused ankle. Patients that have their ankle fused will nearly always develop arthritis in these adjacent foot joints within 7-10 years after fusion.
Since 2005, there have been several revolutionary implants designs that have completed the FDA process. These newer designs have significant advantages over the previous devices, including ease of placement and refined instrumentation for accuracy of placement. Our clinic has experience with the following US designs:
APEX 3DTM InboneTM; InfinityTM; InvisionTM; CadenceTM; Salto TalarisTM; STARTM; VantageTM; and Zimmer Trabecular MetalTM.
Dr. Jeffrey Christensen has significant expertise in this area, having performed ankle joint replacements since 2003. Currently, he has one of the busiest total ankle practices on the west coast.. Dr. Christensen has performed over 700 total ankle surgeries and is heavily involved in teaching total ankle surgery to surgeons and lecturing at national and regional meetings. He also has published and is actively performing research on total ankle replacement and ankle arthritis. He is on the APEX 3DTM surgeon design team for Paragon28,Inc.
The main advantage of an ankle prothesis is the preservation of motion at the ankle. This is important for walking, hiking, bending, and climbing stairs. The ideal person for ankle replacement is someone with end-stage arthritis, over 50 years of age, not involved in strenuous activities, and not too heavy. After surgery, patients can walk, climb, hike, swim and bike. Activities that are to be avoided include: running, court sports, jumping, or heavy labor that includes lifting. Patients with advanced diabetes, poor bone quality or poor circulation are not good candidates for this surgery.
The surgery usually involves 1 night in the hosptial. The post-operative course involves close monitoring at the clinic. Range of motion can be initiated after the incision is healed. Weightbearing is delayed until bone stabilization has been completed which takes about 4-6 weeks.
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