Ankle Replacement


Ankle replacement surgery began in Europe during the 1970's. Since that time the technology has been researched and refined throughout the world. The technique, implant designs, materials and instrumentation has improved to accommodate the rigorous demands of ankle joint function. For those patients who suffer from end-stage osteoarthritis, post-traumatic arthritis, or rheumatoid arthritis ankle replacement surgery has become an attractive treatment option. In previous years, an ankle arthrodesis or fusion (fusing the leg bones to the ankle bone), which restricts motion to the ankle joint, has been the sole treatment option for these patients. Ankle joint arthrodesis has been the "Gold Standard" for ankle joint salvage. However, this procedure is not without disadvantages and complications. The disadvantages of ankle arthrodesis include restriction of ankle motion causing a limp, transference of stress loads to adjacent joints increasing the risk of joint damage, and nonunion (when the ankle joint fails to unite). In patients that meet the criteria for implantation, ankle joint replacement affords the patient improved ankle joint motion which allows for a more normal gait cycle, decreases adjacent joint stress loads and reduces or completely eliminates ankle pain.

Typically, the procedure takes approximately two-three hours to complete. General or spinal anesthesia is required. The usual hospital course requires a one to three day hospital stay following surgery. Typically, a lower leg cast is utilized for a period of six to eight weeks to obtain healing. Following cast immobilization, weight bearing is then permitted in a removable walking boot and physical therapy is initiated to help achieve maximum motion at the ankle joint.

In the past couple of years, there have been some new implants designs that have cleared the FDA process. These new implants have significant advantages over the previous devices, including ease of placement and refined instrumentation for accuracy of placement. All of the current US total ankle replacement designs - Trabecular MetalTM Total Ankle (Zimmer), InboneTM (Wright Medical), Salto TalarisTM (Tornier), and S.T.A.R.TM Total Ankle (SBi) are available through Dr. Stephen Frania, DPM.

Total ankle replacement, also called ankle arthroplasty, may be recommended to repair an ankle joint that has been severely damaged. Such damage is often caused by arthritis - including osteoarthritis, rheumatoid arthritis or post-traumatic arthritis - or by fracture, infection or other causes.

What is Arthritis?

Arthritis is a medical condition which affects the body's joints and is a major cause of debilitating pain and disability for many people. In fact, up to 50 million American adults reported being told by a physician that they have some type of arthritis.

There are more than 100 types of arthritis. But, the most common form is osteoarthritis, which develops as we age. In this condition, the thin cartilage covering on the ends of the bones becomes worn and frayed, resulting in inflammation, swelling and pain. It affects nearly 27 million Americans, most of whom are 45 and older.

Arthritis can also occur following injury to a joint. This is known as traumatic arthritis. It may develop months or years after a severe sprain, torn ligament or broken bone.

Rheumatoid arthritis is a systemic disease in which the immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints. 1.3 million adult Americans have been diagnosed with Rheumatoid arthritis.1 It most commonly occurs in the hands and feet.

Common Types of Ankle Arthritis

The most common types of arthritis affecting the ankle joint are osteoarthritis (degenerative), rheumatoid arthritis (inflammatory), and post traumatic arthritis.

  • Osteoarthritis is the breakdown or degeneration of the joint's cartilage and formation of bony spurs in the joint.
  • Rheumatoid arthritis in an immune system disease resulting in inflammation of the joint lining which in its advanced stages can lead to cartilage, bone and muscle damage.
  • Post traumatic arthritis is often related to sport, car accident or recurring injuries.

Diagnosis of Arthritis

Ankle arthritis is diagnosed through a combination of reviewing the symptoms, physical examination and x-rays or other imaging tests.

During your visit, your doctor may ask you a series of questions1 such as:

  • When did the pain start? Is it worse at night? Does it get worse when you walk or run? Is it continuous or does it come and go?
  • Have you ever had an injury to your foot or ankle? What kind of injury? When did it occur? How was it treated?
  • Is the pain in both feet or just one? Where is the pain centered?
  • How active is your lifestyle? What kinds of shoes do you normally wear? Are you taking any medications?

As part of your exam, your doctor may also suggest a gait analysis. This detailed study of how you walk identifies the positions of the bones in your leg and foot as you move, measures your stride and tests the strength of your ankles and feet.

In addition to a physical exam, your doctor may order x-rays or special imaging tests such as a bone scan, computed tomography (CT) scan, or magnetic resonance image (MRI) to determine the extent of damage to the joint.

If rheumatoid arthritis (RA) is suspected, blood tests will show whether you are anemic or have an antibody called the rheumatoid factor, which is often present with RA.