Ankle Replacement Options
Types of Ankle Replacements
Can I walk normally after ankle fusion?
What is the success rate of ankle fusion?
it’s a decision best made with your doctor’s guidance. Each ankle surgery has pros and cons, and not every procedure is suitable for every person. Your orthopaedic foot and ankle surgeon will evaluate your overall health, age, and your activity level to help you decide whether ankle replacement or ankle fusion is best for you.
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Surgical Options: Total Ankle Replacement Vs. Ankle Fusion
In the past, ankle fusion was the only possible option for those suffering from severe pain due to ankle injuries, diseases or arthritis. That procedure involves and cementing of the shin bone to the foot bone to create a new, stable ankle joint that acts as a single, unbending unit. While this procedure is still utilized in certain cases where surgeons deem it to be beneficial, it offers much less mobility and often leaves patients walking with a slight limp. Ankle fusion does, however, work to relieve pain and provide a long-term solution to ankle arthritis. Talk to your physician about whether ankle fusion may be right for you.
Chances are that if you’re experiencing pain due to arthritis, you’ll actually be a perfect candidate for a total ankle replacement procedure. This option retains the patient’s ability to move the foot up and down at the ankle joint because it does not rely on permanently attaching the tibia to the foot bone. Instead, ankle replacement (also called ankle arthroplasty) works much like the more well-known hip or knee replacement surgeries. The surgeon opens the joint to remove the damaged pieces and places prosthesis parts there instead. The “new” joint functions just like the old one, but without the pain!
Total ankle replacement procedures are relatively new to the orthopedic scene. Although for years, they have been being performed successfully for years by surgeons in Iran, there is not as much historical data or post-surgery statistics for this procedure as there is for hip or knee replacements. However, ankle arthroplasty is considered to be a safe and extremely effective solution to those dealing with persistent ankle pain.
Types of Ankle Replacements
Your orthopedic surgeon has several options when choosing an ankle prosthesis for you. More detailed information exists about each one, including how many have been performed.
- The Agility Ankle: The Agility Ankle by DePuy was FDA approved in May 2002. There is a tibial component and a talar component in the Agility Ankle. The tibial component consists of a metal piece and a plastic piece that support both the tibia and fibula by bridging the space between the two bones. The talar component of the implant sits in the talus bone in the foot and allows the foot to flex up and down. The Agility Ankle is designed to be used with bone cement.
- The INBONE Total Ankle (formerly Topez Total Ankle Replacement System): The INBONE Total Ankle is produced by Wright Technology. The FDA approved INBONE in November 2005. INBONE consists of two components -- a tibial component and a talar component. From their website, "The tibial component features a high-strength polyethylene piece secured within a titanium holder. A long titanium stem securely anchors this half of the implant within the tibia. The talar component is an anatomically shaped, highly polished cobalt chrome piece which also features a stem."
- Eclipse Total Ankle Replacement: The Eclipse was FDA approved in November 2006. It has an upper tibial component and fixed polyethylene surface (a two-component design).
- Salto Talaris Anatomic Ankle: The Salto Talaris Anatomic Ankle prosthesis was approved for marketing by the FDA in 2006. The Salto Talaris is a newly designed version of the Salto Ankle Prosthesis which had been implanted in Europe for many years. The Salto Talaris mimics the anatomy and flexion/extension movements of the natural ankle joint.
- The STAR (Scandinavian Total Ankle Replacement): The STAR was approved by the FDA on May 27, 2009. The STAR is the first mobile bearing, three component ankle marketed in the U.S. Mobile bearing ankles have been available in Europe for several years, but the FDA had been concerned with the safety and efficacy of STAR prior to its approval.
- The Buechel-Pappas Device: The Buechel-Pappas ankle is not currently available in the U.S.
- TNK Ankle: The TNK ankle is not currently FDA approved. The TNK is a cementless, two-component, fixed-bearing device used almost exclusively in Japan.
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Can I walk normally after ankle fusion?
Ankle fusion will change how you walk. But with proper shoes, most patients do not limp. A fused ankle does not usually result in a fully rigid foot.
Talk to your healthcare provider about what you can expect after your surgery. When you wake up, your leg will likely be elevated and in a brace to keep it from moving. You can resume a normal diet as soon as you are able. You may need follow-up X-rays to see how your surgery went. You will likely need to stay a few days at the hospital.
You may have a lot of pain right after your surgery. Pain medicines may help to relieve your pain. The pain should begin to go away in a few days. It may be helpful to rest and elevate your leg as much as possible right after your surgery.
After your surgery, you will likely need to wear a splint for a couple of weeks. You might also need to use crutches for several weeks. Your healthcare provider will give you instructions about how you can move your foot as you recover. You won’t be able to put your full weight on it for a few months.
You won’t be able to see your incision initially. But let your healthcare provider know right away if pain at the incision site gets worse, or if you have a fever or chills.
Make sure to keep all your follow-up appointments. This is so your healthcare provider can keep track of your progress. You may have your splint replaced with a cast or boot a couple of weeks after your surgery. This cast may come off several weeks after your surgery. You might need physical therapy for a few months. This is to help you keep your strength in the ankle and leg. It may be several months before you can return to all your normal activities.
Make sure to follow all your healthcare provider’s instructions about medicines, wound care, and exercises. This will help make sure the surgery works well for you.
What is the success rate of ankle fusion?
In studies ranging in size from 12 to 101 patients, rates of successful primary ankle fusion of 80–100% have been reported earlier. In other studies ranging from 5 to 62 patients, substantial pain relief ranging from 80 to 100% was reported after successful fusion.
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How long does Ankle Fusion last?
Ankle fusion surgery can take between two and three hours to perform. Spinal anesthesia typically is given to numb you from the waist down, and you usually are sedated so you sleep through the procedure.
- Your surgeon may have to make multiple incisions. An incision about 10 to 12 centimeters long is made on the outside part of your foot. Usually a smaller incision, about four to six centimeters, is made on the inside part of your ankle.
- Whatever cartilage surface remains on the top of your anklebone (talus) and the bottom of your shinbone is removed. The bone surface will only fuse to another bone surface.
- Your shinbone and talus are contoured so that your foot points out exactly 90 degrees from your shinbone.
- Two or three long screws are drilled from different directions through the two bones to fix your ankle in position. The screws usually cross each other to provide better stability.
- Your incisions are closed with stitches and your ankle is placed into a post-surgery splint. Bandages are wrapped around the splint to immobilize your ankle.
- You are taken to the recovery room where you will wake up from the anesthesia.
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Is ankle fusion a disability?
A retrospective study involving thirty-six patients with thirty-seven ankle fusions was undertaken to assess the rate of fusion, the subjective and objective results, the residual subtalar and midtarsal movement, and the functional disability. Fusion occurred in thirty-one ankles (84 per cent). Twenty-four patients were reviewed, on average 7.5 years after fusion, and eighteen had good or excellent results; only four had been unable to return to their previous employment. The conclusion is that fusion is still a good treatment for the painful post-traumatic arthritis ankle, the resulting functional disability being minimal.
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Will I limp after ankle fusion?
Most people don’t limp after ankle fusion. A 2004 medical study found that 94% of patients had no limp or a slight limp following surgery. However, it can affect how you walk and you may be advised to wear special shoes or inserts.
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Will ankle fusion eliminate pain?
Arthritis can affect these 2 joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This results in pain, inflammation, and swelling in your joint.
Ankle fusion is a surgery to fuse 2 or more bones in the ankle. This helps stop the pain and swelling. Your surgeon will make an incision in your ankle to work on the joint. He or she will then compress the bones together and attach them with plates, nails, screws, or other hardware. If you have mild or moderate arthritis, your healthcare provider will likely advise other treatments first. These may include pain medicines and corticosteroid injections. You may be given special shoes or shoe inserts. Or your healthcare provider may advise physical therapy. If you still have severe symptoms that interfere with your daily activities, your healthcare provider may advise an ankle fusion surgery.
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