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 TA L Ankle Replacement

By Dr. Michael M. Cohen, DPM, FACFAS

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 commit⊲ Dr. Cohen is a published author, is on faculty at several South Florida residency programs, podiatric medical colleges and ment to physical therapy and frequent lecturer. He practices rehabilitation. The success rate is very good with the Foot, Ankle and Leg Specialists of South Florida specializing in lower leg injuries with modern ankle replace- and reconstructive surgery of ments oftentimes lasting from 12-18 years. Studies show that patients preferred the outcome the foot and ankle. The practice includes Robert Sheinberg DPM, Al DeSimone MD, Fernando Moya MD PhD, Alexander Bertot of ankle replacement over the MD, David Shenassa MD, Carlo fusion which bonds the joint in one position to eliminate all movement. However, like all Messina DPM, Franz Jones DO and John Goodner DPM. The South Florida Institute of Sports Medicine in Weston is surgery, there are potential complications. These may include infection, scarring, located at 1600 Town Center Blvd., Suite C, (954) 389-5900 and in Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901 nerve damage, and loosening The practice website is www. or wearing of the implant. southfloridasportsmedicine.com

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.

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