Total Ankle Replacement
From Alaska to Vancouver BC, Seattle to Olympia.
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 20 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 replacement preserves 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 cleared the FDA process. These newer designs have significant advantages over the previous devices, including ease of placement and refined instrumentation for accuracy of placement. Most of the major US total ankle replacement designs: Inbone Total Ankle™ and Infinity™ total ankle (Wright Medical); Cadence Total Ankle and Salto Talaris™ (Integra Life Sciences), STAR™ Total Ankle (Stryker, Inc), and Zimmer Trabecular Metal (Zimmer Surgical) have been placed our patients at Ankle & Foot Clinics Northwest. The advantages and disadvantages are understood to optimize placement.
Dr. Jeffrey Christensen has significant expertise in this area, having performed ankle joint replacements since 2003. He was the first surgeon in the Seattle area to place the STAR total ankle. Dr. Christensen has performed over 500 total ankle surgeries and is heavily involved with 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.
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.
TOTAL ANKLE LINKS:
- Cadence® Total Ankle
- Infinity® Total Ankle
- InBone® Total Ankle
- STAR® Total Ankle
- Zimmer® Total Ankle
- American College of Foot and Ankle Surgeons: Position Statement
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