Do You Need Ankle Replacement?

with Stephen Cox, MD

YOUR FEET AND ANKLES BEAR THE BRUNT OF YOUR entire body weight… they allow you to walk and dance and they are an amazing option to get you from one place to another. Over time, osteoarthritis (wear and tear arthritis that results with age), post traumatic arthritis (arthritis from past injury of the joint) and/or rheumatoid arthritis (a system-wide arthritis that affects your joints) can cause pain, inflammation and stiffness that can make walking difficult. Your mind may be saying let’s get up and go, but your joints are saying something completely different.

Most of my patients initially come to see me because foot and ankle pain has begun to interrupt their daily activities. After an evaluation, we begin to talk about options. If the patient has mild to moderate arthritis, it is best to initially consider nonsurgical options:

• Special shoe and foot inserts

• Pain and anti-inflammatory medications

• Physical therapy

• Corticosteroid injections

If pain persists after conservative treatments, it may be time to consider surgical options. If the arthritis has not progressed severely, arthroscopic debridement maybe be a choice. If the arthritis is severe, end-stage, then it may be time to consider ankle fusion or ankle replacement. All the choices have risks and benefits. Before considering any of these surgical options, it’s super important that I have an honest conversation with my patient about their expectations following surgery, while considering their lifestyle, age, health and current activity level. So, let’s talk about ankle replacement versus ankle fusion.

ANKLE REPLACEMENT:

Ankle replacement (ankle arthroplasty) surgery is the replacement of the ankle joint with an artificial implant that is made of metal and a high performing plastic. The ankle joint (tibiotalar joint) is where your shinbone (tibia) rests on top of the foot, the talus. As arthritis progresses, the smooth cartilage on the surface of your bones can wear away. You may be told you are “bone on bone.” Ankle replacement requires the bone to grow into the artificial joint, so that the new joint can work properly. If this does not take place, complications could incur that include ankle weakness, stiffness and instability. Following ankle replacement, patients typically will regain a greater range of motion and are able to return their active lifestyles quickly. On average, the patient will wear a cast and be non-weight bearing for three to six weeks to be followed by physical therapy. Recent studies show that the artificial ankle prothesis has a lifespan of 10+ years. The recovery period for ankle replacement is typically shorter than it is for ankle fusion. Ankle replacement is most often considered when patients want to continue their active lifestyles and are typically over age 50 and in overall good health without compromising comorbidities.

Ankle Fusion

Ankle fusion (arthrodesis) is more common than ankle replacement. Ankle fusion involves cleaning out the worn-out ankle joint and fusing bones together with screws, plates, and bone grafts. During the healing process, the bones fuse into one combined bone. Ankle fusion is successful with relieving ankle pain due to arthritis, but it does reduce the ankle joint’s ability to move causing other joints to compensate to allow for movement. The stress on the other joints can eventually result in arthritis in those joints. Following an ankle fusion, patients spend 10-12 weeks in a cast, but because the ankle joint is “locked” into place, physical therapy is rarely part of the recovery process. Ankle fusion is most often considered when patients want to be done with their ankle pain or for those in which total ankle replacement is not an option: those who are overweight, have a condition that has resulted in nerve damage, paralysis, a history of infection, diabetes or avascular necrosis. Some patients who have ankle fusion may be candidates for ankle replacement surgery to restore motion and function.

When determining what option is best for you, it is best to weigh the pros and cons with your orthopedic foot and ankle surgeon. Not every procedure is best suited for every patient. After a careful review of your overall health, age, and activity level, you and your orthopedic surgeon can make a joint decision on whether ankle replacement or ankle fusion is the best and healthiest choice for you. Above all, I want to make sure that my patients are aware that I will do my best to ensure a successful surgery and the patient must do their best to play an active role in their healthy recovery… we’re a team and we have to work together toward the best possible outcome.

Stephen Cox. MD is a fellowship trained orthopedic surgeon specializing in disorders of the foot and ankle. To schedule an appointment with Dr. Cox or one of his partners at Orthopedic Specialists of Louisiana, please call or visit: (318)543-BONE or orthopedicspecialists.la