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Total Ankle Replacement surgery an option to help keep boomers active Print E-mail

Dr. Nicholas Abidi
By Dr. Nicholas Abidi

A recent New York Daily News article reported that U.S. baby boomers are fueling a wave of joint replacement surgeries, a consequence of an active lifestyle that often accelerates the arthritis wearing down their joints.

Sports involving pivoting--basketball, racquetball, volleyball, soccer, tennis, etc.--can result in sprained ankles and fractures that make your ankle susceptible to future injuries, and eventually arthritis. If you've been a fan of these activities, then you may have just found the root cause of your current ankle pain.

With the stresses placed on the complex ankle joint, development of an effective and durable replacement has been difficult, resulting in high failure rates for early ankle replacements. This drove many surgeons to abandon Total Ankle arthroplasty and return to fusion, the gold standard to treat severe and chronic ankle pain.

While this reputation has lived on with many referring physicians, recent product improvements in ankle replacements are creating a market that is poised to explode, according to medical research organizations.

Total Ankle Replacement implants available now are more reliable and, if you're the right candidate, may be the answer to beat your pain and return you to mobility.

While understanding fusion and ankle arthroplasty procedures is important, it's critical to find a board-certified orthopaedic surgeon who specializes in Total Ankle Replacement surgery. Across the board, orthopaedic surgeons agree that the skill of the surgeon is even more critical to success than the devices themselves.

In addition to total hip and knee replacements, I have performed hundreds of total ankle arthroplasties since 1997. I was one of the first orthopaedic surgeons to help re-introduce total ankle arthroplasty to California after arriving in 2000. I've authored several publications on ankle arthritis and led an international meeting that focused on ankle arthritis in Denver in 2008.


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For an ankle fusion, your surgeon removes the surfaces of the ankle joint to promote the growing together of the lower leg bones, the tibia and fibula, with the talus, a critical bone in the ankle joint that connects the leg to the foot.

While fusion eliminates the often debilitating pain, patients are left with decreased mobility and a stiff step that affects most types of activity.  Ankle stiffness can translate stress to surrounding joints in the foot that can lead to arthritis in those joints requiring further surgery over the long term.

Newer ankle replacements from manufacturers such as Tornier and Wright Medical are proving increasingly reliable. The companies include precise cutting guides and jigs that enable surgeons to attain precise fits and repeatable results.   Patient’s walking patterns (gait) after ankle replacements have been demonstrated to be closer to that of a non-arthritic patient than after ankle fusion.

In a Total Ankle Replacement, your surgeon will use the anterior approach to make an incision in the front of the ankle, providing the optimum way to visualize the area and make proper cuts for the inserting the implants.

Depending on your condition, he or she may use the Tornier implant, a cone-shaped device that has a better relationship with the human anatomy in recreating normal joint function, according to its manufacturer. Highly precise cutting guides and jigs specific to the implant enable surgeons to more precise fits and obtain repeatable results.

Alternately, Wright-Medical describes its Inbone II Total Ankle Systems as a modular, customizable implant with the first and only precise intramedullary (inside the bone) guidance system. The system allows the surgeon to use fluoroscopy to make sure the implant stays in the right place during the phases of the procedure. This prosthesis is used by Dr. Abidi for heavy patients, those with complex deformities or prior ankle or hindfoot surgery.

Your ankle replacement surgery may be done under general anesthesia or spinal anesthesia, which leaves you awake but unable to feel anything below the waist. After your surgery, you’ll be fit with a cast or a splint. A small tube that helps drain blood from the ankle joint may be left in your ankle for one or two days, so expect to stay in the hospital for three to four days. Lower extremities will typically heal more slowly than other areas of the body. Your surgeon and hospital staff will monitor swelling and make sure infections don’t occur.

To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting. You must stay non-weight bearing for six weeks, followed by physical therapy and convalescence that takes about six months.

Remember to choose a surgeon with a history of ankle replacement success, with excellent referrals from other physicians. Reviewing medical feedback sites can be helpful, but as with all online information, it’s a good idea to take an aggregate view of what you read. Only a small subset of patients will take the time to leave comments, their experiences will vary widely, as will their personalities and their perspectives. Try to read patient stories or watch their videos on the doctors’ Web site, and if possible, talk to patients themselves.

If you’re the right candidate, a Total Ankle Replacement may be the best option to alleviate your ankle pain, restore your mobility, and make a significant improvement in the quality of your life.


 

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Community Talk July 28, 2014 6:30pm

Join Dr. Nicholas Abidi, M.D., Dr. Peter Reynolds, M.D. and  Dr. Christian Heywood, M.D. as they discuss knee and hip pain and the available treatment options.

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