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Ankle Replacement Rapidly on the Rise

Arthritic hips and knees are replaced all the time—but did you know that arthritic ankles can also be replaced? In fact, ankle replacements in the U.S. more than doubled last year, thanks in part to advances in ankle implants (prostheses).

Total ankle replacement surgery—also called ankle arthroplasty—involves replacing a damaged joint with an artificial joint. The procedure greatly improves function for people who cannot perform everyday activities without experiencing severe pain. Arthritis and previous injuries are the most common causes of this pain.

In the past, the gold standard for treating these problematic patients was a fusion, or arthrodesis, in which the joint is removed and the bones are fused, thereby taking away the pain but also rendering the ankle immobile.

The treatment of choice is rapidly changing and foot and ankle surgeons believe they will see fewer fusions and more ankle replacements in the future with more implants currently available and FDA approved.

Patients undergoing ankle replacement are typically in their 40s through 60s, although older individuals who are “physiologically young” may also be good candidates. Surgeons have performed the procedure on individuals ranging in age from 38 to 83 years of age with great success, despite the age differences.

The procedure takes about two hours. After making an incision on the front portion of the ankle, the surgeon removes the arthritic bone and cartilage from the tibia (leg portion of the ankle) and talus (foot portion of the ankle). The implant typically consists of two metal components and a plastic spacer that fits between those metal components. These are then inserted to form a new ankle joint.

What can you expect from a total ankle replacement? Patients enjoy vastly improved function of their ankle, with pain-free weightbearing and range of motion.

This contrasts sharply to the results achieved from fusion, which not only eliminates ankle movement but also increases the chances of developing arthritis in adjacent bones due to ankle immobility.  

Ankle implants generally last at least a decade. Many implants implanted in the 1990s still function well. That will improve with today’s technologically advanced prostheses and surgical techniques.

Although total ankle replacement has been around for more than 30 years, only recently have industry breakthroughs expanded the choices of effective implants. In the late 1990s, only one ankle prosthesis was FDA approved in the United States. Today, surgeons can select from four FDA-approved prostheses.

Surgeons note that not everyone is a candidate for an ankle replacement. For example, people with poor blood flow (peripheral arterial disease), loss of sensation (neuropathy) or significant deformity related to a birth defect or previous traumatic event should not undergo this procedure.

For those who do meet the criteria for consideration, ankle replacement offers tremendous advantages over previous treatment for severe ankle pain related to arthritic changes. With the growing number of surgeons now being trained to perform this procedure, ankle replacement is likely to flourish as an effective treatment for painfully arthritic ankles.