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Total Ankle Replacement Surgery

What is an Ankle Replacement?

Ankle replacement is an alternative to ankle fusion that has been available for many years. Recent advancements in technology have made it a preferred option for many patients. The surgery involves removing the worn-out surface of the arthritic ankle and replacing it with a smooth metal and plastic bearing that allows motion and reduces and often eliminates pain. It is like knee and hip replacement which are more common in today’s world. Ankle replacement surgery is done by orthopedic surgeons who have specialty training an both corrective foot surgery and special experience in ankle replacement surgery.

What is an ankle fusion?

Ankle arthritis develops when the joint surface (cartilage) wears away leaving a rough, pitted and often deformed (crooked) joint that does not move freely and causes pain due to loss of cushioning between the foot and the leg. Patients with severe pain from this condition who have failed non-invasive options often are faced with ankle fusion surgery. Fusion is a procedure where the joint surfaces are removed, and the bones are screwed together so that they no longer move. While this often improves pain, all motion of the joint is lost, forcing that motion into other joints of the foot and leg. This can lead to arthritis of other joints as the patient ages, potentially leading to more fusion surgery.

Ankle replacement is often an alternative to ankle fusion for patients who have developed severe arthritis due to:

Osteoarthritis: Familial and normal “wear and tear” arthritis

Traumatic Arthritis: Arthritis that is the result of a broken bones, sports injuries or multiple sprains

Inflammatory Arthritis: Due to rheumatoid arthritis, gout, autoimmune disease, and blood disorders

Ankle replacement is appropriate for patients who wish to maintain and active lifestyle including walking, hiking, low impact exercises such as swimming and cycling. Advantages to successful ankle replacement often include alleviation of pain, improved motion, and gait (limping). The advantage of maintained motion in the ankle protects other joints from increased wear and tear and may protect other joints of the foot and knee from the abnormal wear associated with ankle fusion.

New technology in Total Ankle Replacement:

Total Ankle Replacement has seen a massive investment in technology by the orthopaedic implant industry in the last 10 years. These have led to real improvements for patients both in the shortening recovery and in the improving success of the procedure. Notable improvements have included:

  • Individually Customized Surgery: A 3-dimensional scan of the ankle is done to aid with planning of the surgery. The surgery can be planned virtually using 3-dimensional computer models and custom guides for use in the operating room are printed for individual patients. Computer guidance allows the procedures to be done with improved precision and accuracy.
  • Custom Implants: Missing, collapsed, and malformed bones can be replaced with 3D printed technology. A new talus bone can be printed to replace (not just resurface) a dead (Avascular Necrosis) or missing bone.
  • Improved Implants: Implants have been improved to correct failures seen in earlier generation implants. These include surfaces that make the implants less likely to loosen and components that are more resistant to wear (better designs and materials, tougher and longer lasting materials).
  • Revision Total Ankle: Several companies have created devices designed to replace ankle older ankle replacements that have worn out.

What are the Risks of Ankle Replacement?

As with all joint replacement surgeries, ankle replacement carries with it a risk of infection, damage to nearby nerves and arteries, bleeding and blood clots, anesthetic complications, and malalignment (crooked) bones or implants. Risks specific to ankle replacement include loosening of the joint replacement and wearing out of the metal and plastic components. Your own risks cannot be adequately summarized on a web page as they vary depending on your health and medical conditions. A detailed discussion of the risks of the procedure should be undertaken with your surgeon prior to the procedure.

What if I want to avoid surgery?

Talk to your physician. Often the symptoms of arthritis can be improved with non-surgical modalities such as ankle bracing, medications, physical therapy, and injections.

Which Implant is Right for Me?

Dr. Sammarco works directly with ankle replacement manufacturers to develop and evaluate new technologies, improve implants, and improve instrumentation for patients. While many surgeons use only one device or company for their patients. Dr. Sammarco’ s surgical volume has afforded him the opportunity to work with multiple implants and manufacturers, allowing him to choose the implant that best fits the patient. Different implants feature different technologies which may include fixed or mobile bearings, bone ingrowth or cement fixation and variable amounts of deformity correction that can be accomplished.

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