The ankle joints support our full body weight during motion, when we walk, stand or run. Even though our ankles are the smallest surface area, they are one of the major weight bearing joints in our body. An average height and wight female can put a force equivalent of 50+ metric tons on each foot, for men pressure can reach 80-90 tons per foot. If you are overweight or obese, the impact on your ankle joints is even greater.
If you experience ankle pain and decreased function from arthritis after trying conservative management, you might be a candidate for Ankle Joint Replacement. Conservative management includes anti-inflammatory medication, bracing, physical therapy, activity modification and pain medication.
During Ankle Joint Replacement surgery the diseased cartilage and the ends of the damaged bones are removed and a replacement joint (implant) made of plastic and metal is fitted onto the bones.
Dr. Nicholas Abidi performs about 35-40 Ankle Joint Replacements per year since 1997. He also performs almost as many ankle fusions per year. As the outcomes became more predictable about 10 years ago, ankle replacement numbers have started to eclipse ankle arthrodesis.
From Dr. Nicholas Abidi:
“Total ankle replacement patients are generally older than 55, have systemic inflammatory arthritis in the joints surrounding the tibiotalar joint and have failed conservative care with a brace and a steroid injection. These patients have to have normal sensation and normal circulation and can not have a significant varus or valgus deformity of the tibiotalar joint. Patients should also have Body Mass Index of 35 or less.Patients with diabetic neuropathy, history of infection or significant deformity of varus or valgus deformity of over 15 degrees may be better for a staged procedure leading to an ankle replacement, or an ankle fusion or combined ankle/subtalar fusion. Also, patients younger than 55 without systemic autoimmune inflammatory diseases may be candidates for reversible anterior ankle fusions. These types of fusions may be reversed to a total ankle arthroplasty (ankle joint replacement) in the future.With the current, third generation ankle replacements, we have been able to tackle more complex deformities than before, thanks to pre- op CT scan planning, improved materials and instrumentation. The procedures can be as reliable as knee replacement surgery.”
Ankle replacement patients are the happiest patients Dr. Abidi sees post-operative. They can generally walk to their first post- op appointment without assistance devices, special shoes or braces. After the procedure, patients experience the profound improvement in quality of life, 3-dimensional range of motion, freedom from pain, and a “natural feeling” ankle.
Moreover, when motion of the ankle is preserved in a Ankle Joint Replacement, the surrounding joints are also protected from the increased wear and tear. After the ankle fusions, there is a risk for progressive arthritis in the next 10- 15 years after the procedure. On the other hand, Ankle Joint Replacement helps preserve the surrounding joints from arthritis.
Advancements in orthopedic technology continue to revolutionize surgical options. Today’s surgical instruments and implants make orthopedic surgery more precise and more effective than ever before. New generation ankle replacements mimic the anatomy and flexion/extension movement of the natural ankle joint, and are an alternative to traditional ankle fusion.
The innovative implants Dr. Abidi uses during Ankle Joint Replacement are: Wright Medical total ankle and The Salto Talaris Total Ankle Prosthesis, Tornier, which has been modeled after the human anatomy and is redefining the classic approach to ankle arthroplasty, is the leading total ankle replacement in the US.1 The innovative Salto Talaris provides surgeons the ability to reproduce the natural flexion/extension axis of the ankle with an anatomic design. The Salto Talaris implant design and instrumentation is founded on the Salto mobile-bearing ankle prosthesis, which has been in clinical use since 1997.
