Ankle Fusion & Ankle Replacement
Arthritis in the ankle joint can destroy or damage cartilage creating severe pain that affects one’s lifestyle. If bracing and anti-inflammatory injections don’t bring relief, the two surgical treatment options are to either fuse the ankle or replace it with an artificial joint.
Replacements of the knee and hip joints are more common than ankle replacements because the causes are different. Unlike in the knee or hip, it is rare for arthritis to occur naturally in the ankle. Ankle arthritis most commonly occurs after a traumatic event.
Advances in automotive safety, lower extremity reconstruction and limb salvage after trauma have allowed survivorship and prolonged function of the lower extremity. However, more people who have had such trauma are eventually experiencing debilitating pain and impaired ankle function as they grow older. For these people, ankle fusion or ankle replacement may be the best option.
Ankle fusion has been the standard of care for such conditions. But as the technology of ankle replacement improves, more and more people are choosing that option. Some people are good candidates for fusion and others for ankle replacement. Many may have the option for either.
Both surgeries may be done on an inpatient or outpatient basis. Recovery from an ankle replacement is generally quicker than from ankle fusion.
Potential patients for ankle fusion or ankle replacement first need to decide whether their pain is a big enough problem for them to warrant going through the potential risk from the surgery and the recovery process. They should thoroughly discuss the pros and cons of each procedure with their orthopedic surgeon.
In ankle fusion surgery, an orthopedic surgeon fuses the leg bone to the anklebones using either an external or internal method. External fixation involves surgical pins joining the leg and anklebones with an external rod and pins holding the bones in place until they fuse together. Internal fixation generally involves removing the cartilage at the ankle joint and compressing the ankle and leg bones together with plates and screws to fuse them.
Many people have the misconception that ankle fusions don’t turn out well and that ankle fusion patients still have great pain and walk with a limp. That’s not the case. Fusing the ankle is the most reliable way to get rid of pain, and many patients can still walk normally without a limp. The ankle will most likely have a reduced range of mobility after ankle fusion.
The drawback to fusion is that the joints in the foot below the ankle have to make up for that loss of ankle motion. Those joints are not designed to work that way and will become arthritic and painful. This is called adjacent segment disease.
Those lower joints may eventually need to be fused as well, and that results in limited function, with very stiff movement and a limp. Everyone with a fused ankle eventually develops adjacent segment disease in the lower joints, generally after 20 years. However, this is not painful for everyone.
By maintaining motion, ankle replacement prevents the fusion problem of adjacent segment disease from occurring. Patients who have had fusion of joints below the ankle are often good candidates for ankle replacement.
In ankle replacement, a prosthetic ankle made of metal and/or plastic replaces damaged ankle and leg bone surfaces. Dr. Joseph Kou and Dr. Murali Moorthy, who perform ankle replacements for Muir Orthopaedic Specialists, primarily use the STAR ankle replacement device because they consider it to be the best option available. It has proven to have a 90 percent survivability rate after 10 years, meaning that 90 percent of patients are still using the devices after 10 years.
However, there are no studies that evaluate any prosthetic ankle beyond that time frame. It is possible that an ankle replacement will have to be redone after that length of time. Ankle replacement devices and procedures are still being refined and are not considered to be as advanced and dependable as hip and knee replacements, though advances are continually being made.
One problem with current ankle replacement devices is that if something fails and fusion is the fallback option. That procedure is more difficult because a considerable amount of bone has been removed to facilitate the replacement.
The vast majority of ankle replacement patients report that their pain is completely gone or is much better. Most eligible candidates for ankle replacement are choosing that option due to the proven 10-year durability of the operation and the prospect of retaining the range of motion that a prosthetic ankle joint allows.
If you are experiencing ankle pain associated with ankle arthritis, contact us to request an appointment with our orthopedic ankle specialists.