The Total Ankle Replacement

Ankle arthritis involves the loss of cartilage which decreases joint function and ultimately results in pain, stiffness, swelling, and warmth. As the cartilage wears the bones in the ankle joint grind on each other. There are several types of arthritis in the ankle. The most common types are osteoarthritis, a condition which is often a result of previous trauma to the ankle or leg and rheumatoid arthritis. Rheumatoid arthritis is an immune disease resulting in inflammation of the joint lining and in advanced stages will lead to cartilage, bone, ligament, tendon, and muscle damage. Conservative treatment for these conditions may involve medication, injections, activity modification, physical therapy, and bracing. When conservative treatment fails surgery may be considered. This involves fusing (locking the ankle permanently) or replacing it with an artificial joint as are done in the knee or hip joints. The procedure is referred to as total ankle arthroplasty or total ankle replacement.

There are several ankle replacement systems available to the surgeon. Some total ankle replacement systems require more bone removal in order to obtain the desired result, others are referred to as resurfacing systems which remove less bone and essentially replace the surfaces of the joint. Certain ankle replacement systems are used for revision surgery. Today’s total ankle replacements are essentially anatomic and provide the patient with the ability to reproduce the natural movement of the ankle joint. One of the most advanced systems utilizes the Prophecy technique developed by Wright Medical. The Prophecy technique allows precise implantation of the device by using specialized CT scan imaging before surgery. Bioengineers will subsequently map out a customized plan for the individual patient which enhances the success of the operation. The alignment of the ankle is crucial as a neutral (straight) ankle will perform the best in the long term, otherwise, ancillary procedures are required to straighten the ankle and foot.

T H E T O T A L Ankle Replacement

By Dr. Michael M. Cohen, DPM, FACFAS

BEFORE AFTER

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South Florida Institute of Sports Medicine

FOOT, ANKLE, & LEG SPECIALISTS OF SOUTH FLORIDA

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FOOT AND ANKLE ARTHRITIS

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CARTILAGE INJURIES

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SERVING OUR PATIENTS FOR OVER 30 YEARS

Dr. Warren Windram, D.P.M.

Board Qualified FOOT, ANKLE, & LEG SPECIALIST Dr. John Goodner, D.P.M.

Board Qualified FOOT, ANKLE, & LEG SPECIALIST Dr. Robert Sheinberg, D.P.M.

- In Loving Memory Dr. Carlo Messina, D.P.M.

Board Certified FOOT, ANKLE, & LEG SPECIALIST Dr. Michael Cohen, D.P.M.

Board Certified FOOT, ANKLE, & LEG SPECIALIST

WESTON

1600 Town Center Blvd.

954-389-5900 PEMBROKE PINES

17842 NW 2nd St. 

954-430-9901 PLANTATION

220 S.W. 84th Ave., #102 954-720-1530

SATURDAY HOURS Make Your Appointment Online at www.SouthFloridaSportsMedicine.com

FOOT, ANKLE & LEG QUESTIONS? EMAIL THE DOCTOR! DrJohnGoodner@gmail.com (Don’t Send Protected Health Information)

IMEs • Personal Injury • Worker’s Compensation Most HMOs/PPOs • All Foot Ankle & Leg Emergencies Same Day Appointments • Saturday Appointments Early Morning & Evening Appointments

New Patient . . . . . . . . . . . . . . $200 Follow Up Visit . . . . . . . . $50-$100 PRP . . . . . . . . . . . . . . . . . . . . . $600

SELF PAY RATES (Procedure cost is in addition to office visit.) Surgery Consult . . . . . . . . . . . $200 Orthotics . . . . . . . . . . . . . . . . . $350 Shockwave (3 sessions) . . . . $500

(FOR CHRONIC HEEL PAIN & TENDONITIS) Injections . . . . . . . . . .$75 per shot Ingrown Nail . . . . . . . . . . . . . .$125 Laceration Repair . . . . . . . . . $250 Casts . . . . . . . . . . . . . . . . . . . . .$175 X-Rays . . . . . . . . . . . . $50 per area Wound Care . . . . . . . . . . .$75-$125

SPORTS MEDICINE ASSOCIATES (Self Pay Rates Do Not Apply To This Practice Below) Dr. Fernando Moya, M.D.

The specific ankle replacement will depend on the patient’s age, level of disease, and level of activity. The success of an ankle replacement is influenced by the condition and quality of the bone, the type and severity of arthritis, the condition of the muscles and tendons around the ankle, ankle alignment the weight, age, overall health of the patient, and finally the patient’s commitment to physical therapy and rehabilitation.

The success rate is very good with modern ankle replacements oftentimes lasting from 12-18 years. Studies show that patients preferred the outcome of ankle replacement over the fusion which bonds the joint in one position to eliminate all movement. However, like all surgery, there are potential complications. These may include infection, scarring, nerve damage, and loosening or wearing of the implant. Postoperative recovery generally requires four to six weeks in a short leg cast or fracture boot with physical therapy starting thereafter. The postoperative period is an added advantage over fusion which in contrast requires several months of immobilization in a cast.

⊲ Dr. Cohen is a published author, is on faculty at several South

Florida residency programs, podiatric medical colleges and frequent lecturer. He practices with the Foot, Ankle and Leg

Specialists of South Florida specializing in lower leg injuries and reconstructive surgery of the foot and ankle. The practice includes Robert Sheinberg DPM,

Al DeSimone MD, Fernando

Moya MD PhD, Alexander Bertot

MD, David Shenassa MD, Carlo

Messina DPM, Franz Jones DO and John Goodner DPM.

The South Florida Institute of

Sports Medicine in Weston is located at 1600 Town Center

Blvd., Suite C, (954) 389-5900 and in Pembroke Pines at 17842

NW 2nd Street, (954) 430-9901

The practice website is www. southfloridasportsmedicine.com

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