When ankle replacement just makes sense

A severely arthritic ankle may require surgery to eliminate chronic pain. Although fusion surgery is the standard solution, ankle replacement surgery may be a better solution depending on a person’s age, lifestyle and physical condition.

In fusion surgery, all remaining cartilage is removed from the joint, explains Dr. John Grady, podiatric surgeon at Advocate Christ Medical Center in Oak Lawn, Ill. The ankle joint bones are then connected with metal screws and plates, which Dr. Grady says, “takes away” ankle motion.

“Eliminating motion from the ankle reduces its shock absorption and propulsive capacity and transfers stress to the knee and hip joints and the lower back, increasing the risk of those joints developing arthritis,” he says.

With an artificial joint, most motion is retained. “When an artificial joint is implanted, you can walk more normally, move faster and function better. For example, you can put on and take off a pair of boots in normal fashion,” explains Dr. Grady.

Because the artificial joint helps retain motion, ligaments and tendons around the joint remain strong. Following fusion therapy, these tendons tend to weaken and atrophy, he adds.

In ankle replacement surgery, the ends of the damaged bones are removed and an artificial joint is fitted onto the bones. The surgeon also may make needed repairs to the ankle tendons during the procedure. While the patient may only have to remain in the hospital one or two days following ankle replacement surgery, recovery is a longer process. The patient may be unable to stand or walk on the repaired ankle for at least several weeks before gradually putting weight on it.

Until now, fusion surgery has been considered the only option for surgical management of the arthritic ankle, especially for active types. These people are more engaged in walking and other forms of exercise, and ankle replacement joints have had a tendency to wear more quickly as a result of high-impact activities, according to experts.

Dr. Grady, however, is among surgeons using a new, higher tech titanium, polished chrome and plastic joint replacement model that is expected to prove more durable than older implants. “The bone grows into the titanium and holds the replacement joint securely in place,” he says.