Foot & Ankle Reconstruction
Technological advances in ankle replacement are ushering in a new world of pain-free movement for people suffering from debilitating ankle arthritis. While once severely restricted in their activity, those who undergo ankle replacement can enjoy a complete turnaround and actively participate in life again.
According to the American College of Foot and Ankle Surgeons (ACFAS), innovative design and instrumentation, ankle replacement surgery—also called ankle arthroplasty—have vastly improved over the past decade or so, making it a fast-growing, highly successful solution today for those unable to walk without great pain.
“With contemporary arthroplasty, ankle arthritis sufferers who thought their situation was hopeless can get a new lease on life,” says Shannon Rush, DPM, FACFAS, a Fellow Member of the American College of Foot and Ankle Surgeons and surgeon at Palo Alto Medical Foundation, in Mountain View, CA. “For years, they were told they’d always be in pain, but ankle replacement has totally changed their lives—they can now walk with ease, stop going to the pain clinic and stop taking powerful opioid medications.”
Ankle replacement surgery involves replacing a damaged joint with an implant (prosthesis) that serves as an artificial joint. The procedure, which is becoming the treatment of choice, provides important advantages over the historically standard technique of fusing the ankle joint.
“Although fusion eliminates pain and treats the arthritis, it often leaves the patient with a stiff leg and difficulty walking,” says Dr. Rush. “Fusion also increases the likelihood of developing arthritis in the adjacent joints due to ankle immobility.”
In contrast, ankle replacement surgery gets rid of the pain while also maintaining full range of motion. “It lets you walk with a normal gait and perform activities you couldn’t do comfortably with a fusion. It also takes stress off the joints below and in front of the ankle, decreasing the risk of arthritis developing there.”
Ankle arthroplasty is usually performed on people in their 40s through 60s, younger than typically seen with knee and hip replacements. Ankle arthritis is almost always caused by a previous injury. Often, the injury was sustained as a teenager or young adult, and arthritis developed later.
One typical case at Dr. Rush’s practice is a 43-year-old woman who was unable to walk without severe pain due to a fusion performed 20 years ago after a car accident. “Her goal was to walk on the beach, and arthroplasty allowed her to do just that,” said Dr. Rush. “We took her fusion apart and put in an implant, thus treating her arthritis in that lower joint and giving her a return of motion in the ankle.”
The procedure is performed by making an incision in front of the ankle, removing the arthritic bone and cartilage and inserting the implant. A state-of-the-art instrumentation guides the surgeon in making precise cuts in the bone. “More precise cuts mean tighter, anatomically fitting implants, so they’re less likely to be loosened or misaligned,” explains Dr. Rush. Today’s implant—a significant improvement over older designs—usually consists of two metal components and a plastic spacer that fits between those metal components.
During part of the recovery period, patients use crutches, a walker or some other mobility aid to avoid putting weight on the ankle, generally between two to six weeks. It typically takes eight to 10 weeks before the patient can wear a regular shoe.
After several years, the plastic lining of the implant may wear out, but that can often be replaced without revising the metal components. “In general, as long as the metal components are intact, the polyethylene can be replaced through a surgical procedure that requires substantially less recovery time,” says Dr. Rush. Usually after about two weeks, the patient can wear a regular shoe and begin physical therapy.
Although complications can occur with ankle arthroplasty, they are generally well managed by a surgeon experienced in ankle replacement. In selecting a surgeon, Dr. Rush advises, “Look for a board-certified surgeon who is familiar with ankle reconstruction in general. Ankle arthroplasty often requires other reconstructive work, so the surgeon must be competent in other areas.”
Not everyone is a candidate for ankle replacement. For example, people with poor blood flow (peripheralarterial disease), loss of sensation (neuropathy) or significant uncorrectable deformity should not undergo this procedure.
“Given the advances in this procedure and its life-altering benefits, ankle replacement surgery is certainly here to stay,” says Dr, Rush. Clearly, ankle arthroplasty is greatly improving lives and enabling previously pain-ridden people to easily walk, hike, take the kids to the park or just stroll on the beach without pain, discomfort or the need for opioid drugs.