Total Ankle Joint Replacement
Ankle Arthritis is a debilitating condition. It often occurs after an injury but can also result from other conditions such as degenerative joint disease, rheumatoid arthritis, psoriatic arthritis, congenital or acquired foot or ankle deformities, ankle instability, and more. Whatever the cause, the result is chronic inflammation and degeneration of the cartilage which make up the cushioning in the joint. This is often referred to as “bone on bone” and is very painful. The condition is permanent; cartilage does not grow back. To make matters worse, this condition is becoming ever more common with the active aging population. Fortunately, recent technological advancements have come about to meet the growing need.
Like arthritis in any joint, ankle arthritis presents with pain, stiffness and swelling. However, the symptoms are often more pronounced and problematic than arthritis in other areas because the ankle is the smallest weight-bearing joint. In order to walk, the small surface area of the ankle joint must absorb the body’s entire weight. This results in exponentially more pounds per square inch. If the joint is arthritic, each step can be excruciating – often resulting in the ankle “giving out” and the patient collapsing in pain.
Total Ankle Joint Replacement
Conservative treatment for ankle arthritis, as with other joints, includes bracing, anti-inflammatory medications (nsaids), cortisone injections, pain killers, and activity modifications (ie less weight bearing activity). These options often result in inadequate pain relief or are simply unacceptable to patients. Many people are unwilling to wear a brace, take drugs and remain sedentary for the rest of their lives – and who can blame them!?
Traditionally, for those in whom conservative treatment failed, Ankle Fusion was the only surgical option. Ankle fusion means that the bones making up the ankle joint are fused together to form one bone, resulting in no motion at the joint – like an internal permanent brace- and therefore no pain. The down side however is the same – no motion – which leads to altered gait and problems in other joints, difficulty walking on hills or other surfaces, etc. Nonetheless, while ankle fusion remains a good choice for a certain patient population, there is finally a viable alternative for many – total ankle joint replacement.
Total Ankle Joint Replacement
Total Ankle Replacements, or prosthetic ankle joints have been around since the 1970’s, but the first several design attempts failed miserably. While knee and hip replacements evolved to success relatively quickly, ankles required more time to perfect. This is due to the smaller size and increased load on the ankle, as well as more complicated range of motion and difficulty to access surgically. The early designs were so bad that even though we were trained in the procedures, the surgeons at CFAS refused to implant those joints into our patients.
However, in the early 2000’s, this all changed with the advent of the Inbone System by Wright Medical. Its instrumentation was designed in such a way that the implant could be placed accurately. Its prosthetic components were engineered so that stems could be assembled inside the joint for anchoring stability; and so that they would resist wear for longer periods of time. The combination of drastic improvements in the ankle prosthetic itself and the method by which it is installed resulted in an ankle replacement procedure that truly works!
The surgeons at Certified Foot and Ankle Specialists were the first in the area to be trained on and to preform the Inbone procedure and have performed more than any other group in Palm Beach County.
Since then, Wright Medical has advanced ankle replacement even further through the development of the only patient specific, customized CAT (CT) Scan guided ankle replacement system.. The Prophecy. This procedure allows for the same precise placement of the traditional Inbone instrumentation with a significant reduction in operative time under anesthesia, thereby improving outcomes by decreasing complications. Certified Foot and Ankle Specialists surgeons were again the first to be trained on this system and have performed more Prophecy procedures than any other group in Palm Beach County.
Most recently, the INFINITY System was released by Wright Medical. This is also available with the prophecy CT guided customized instrumentation requiring even less o.r. time, and also requires less bone resection which is desirable for a number of reasons.
Limited to physicians with the most Inbone experience per geographical region, Dr Kinmon remains the only surgeon in Palm Beach or Broward counties to be trained on this procedure and to have implanted the Infinity joint in this area.
The ankle replacement procedure itself takes approximately two hours and is performed under general anesthesia. Additional procedures may be required including ligament or tendon balancing for stability and range of motion, osteotomies for alignment or neighboring joint fusions if arthritis exists elsewhere.
Post-operatively, patients spend three days in the hospital for infection prophylaxis, physical therapy gait training, and pain management. They are then discharged home where they remain non-weight bearing in a splint, cast or boot for six weeks. At that time, they will begin bearing weight in the boot and attending physical therapy for the necessary amount of time.
A vast majority of patients who undergo ankle replacement report an immediate decrease in pain which lasts indefinitely. Most also report an increase in range of motion and improved function; ie better ability to perform desired activities. They typically return to light forms of exercise such as walking, hiking, golf, cycling, low intensity weight training, yoga and swimming in short order. Against our recommendation, others have returned to running, heavy weight lifting, scuba diving and tennis.
Are you a candidate? Traditionally, ankle implants were not recommended for patients younger than 50 and above 250 pounds. However, owing to the improvements in designs, we are now able to expand the indications. We also take into account the patient’s overall health and comorbidities, circulation, presence of neuropathy, smoking history and desired post-operative activity level and/or occupation. The decision to proceed surgically will be carefully considered and made together.
If you or someone you know suffers from ankle arthritis, you owe it to yourself to be evaluated by the surgeons with the most experience in ankle replacement to determine whether you might be a candidate for the procedure. There is hope!