Arthritic hips and knees are replaced commonly, but did you know that arthritic ankles could also be replaced? Due to significant advancements in ankle implant design over the past 30 years and multiple recent orthopedic studies showing good to excellent long-term results ankle replacement surgery is becoming more and more popular. Ankle joint replacement more than doubled last year.

Total ankle replacement surgery, also called ankle arthroplasty, involves replacing a damaged joint with an artificial one. The goal of total ankle replacement is to provide pain relief while maintaining motion and improving function.

In the past, most patients with severe ankle arthritis underwent joint fusion, which alleviated pain but created a stiff ankle thus eliminating motion and decreasing function. The treatment of choice is rapidly changing and foot and ankle surgeons believe they will be doing less fusions and more joint replacements to maintain motion and improve function.  

Total ankle arthroplasty is considered for those patients that are experiencing chronic ankle pain and have failed extensive conservative treatments, such as NSAIDs, physical therapy, injections and bracing. Arthritis and history of previous injury are the most common causes of chronic ankle pain.  Patients are typically in their 40s through 60s, although older individuals in their 70 and 80s that are active and relatively healthy may also be candidates. 

Not everyone, however, is a candidate for an ankle replacement. For example, people with poor circulation, diabetics with loss of sensation (peripheral neuropathy) or a history of previous infections – to name a few – should not undergo this procedure. Ankle fusion is still a commonly performed and successful procedure in those patients that do not meet strict criteria for total ankle arthroplasty.

Like hip and knee replacements, complications may occur. Joint replacements may wear down or loosen over time leading to possible infection, pain or other problems even years after the initial surgery. Although most patients do well following total ankle arthroplasty, it is not without risk. Additional surgery is sometimes necessary. Ankle joint replacements typically last 10-15 years. That will improve as advancements in implant technology and design rapidly move forward.

With the growing number of orthopedic and podiatric surgeons now being trained to perform this procedure, better implant design and the ability to improve the functions of daily living, total ankle replacement is rapidly becoming the procedure of choice for painfully arthritic ankles.

The key to successful total ankle arthroplasty is adhering to strict protocols in choosing the right candidate. If you are experiencing chronic ankle pain and have failed conservative treatments and you believe you may be a candidate for total ankle joint arthroplasty, you should consult with a board certified foot and ankle surgeon trained and experienced in performing this procedure.

By Dr. Ralph Napoli DPM

Dr. Ralph C. Napoli is a diplomate with the American Board of Foot & Ankle Surgeons; the chief of Foot and Ankle Service at Active Orthopedics & Sports Medicine; and the director of Foot and Ankle Fellowship at Active Orthopedics & Sports Medicine.

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