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Ankle Replacement By Dr. Michael M. Cohen, DPM, FACFAS
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nkle 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 treat-
ment 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
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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.
