Ankle Replacement Options

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

Read more about: Ankle Replacement VS Ankle Fusion


10 common questions about Ankle Replacement Options

1Are ankle replacements successful?
Ankle replacement is a procedure that has been available for approximately 25 years. However, it has not been as successful as hip and knee replacement surgery. ... Current studies indicate about a 90 percent patient satisfaction rate in the first four years after surgery.
2Which is better ankle fusion or ankle replacement?
Ankle replacement tends to have more risks associated with it, however, than ankle fusion. And the results of this surgery may not last as long as ankle fusion for some people. But ankle replacement surgery does provide more mobility. In the right person, ankle replacement can be an excellent choice.
3How long do ankle replacements last?
How long will a total ankle replacement last? Ankle Replacement: The technology is still evolving, but we are hopeful to get at least 10-20 years out of the replacement. The more high-impact activities you do, the faster you go through the lifespan of the joint replacement.
4What is replaced in an ankle replacement?
Ankle replacement. Ankle replacement is surgery to replace the damaged bone and cartilage in the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones.
5What is the success rate of ankle replacement?
Total ankle arthroplasty revealed a five-year survival rate of 78 percent and a 10-year survival rate of 77 percent.1 The revision rate for total ankle replacement was 7 percent and the revision rate for ankle arthrodesis was 9 percent with the main reason being nonunion.
6Can you drive with a fused ankle?
Driving: ... If your right ankle/foot is the fused one, you are not able to use your right leg to push on the brake or accelerator and are thus not mechanically able to perform the functions associated with normal driving. You should be mechanically able to do the things needed to drive.
7How long are you in hospital after ankle fusion?
After ankle fusion surgery, most healthy patients remain in the hospital for two to three days.
8Why would you need an ankle replacement?
Total ankle replacement surgery is also called ankle arthroplasty, and it's used to replace damaged bone and cartilage in the ankle joint. Using artificial joint parts can help relieve pain, and unlike an ankle fusion procedure, it can also improve motion in your ankle
9How long before you can walk after ankle replacement?
You'll get an X-ray about 6 weeks after surgery. If your ankle is healing well, your doctor might tell you that you can stop using crutches. You'll switch from a splint to a boot that should allow you to start walking on the ankle.
10Will I limp after ankle fusion?
Will I walk with a limp 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.

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