I'm looking into the possibility of having an ankle replacement. What I've found so far is that only certain people qualify for this operation. How do they decide who can get one?
Ankle replacements were first attempted in the 1970s with mixed results. The failure rate was high and interest declined. But improved designs and better ways to hold the implant in place have turned that around. New understanding of ankle biomechanics and motion has also helped scientists develop a more successful second-generation total ankle arthroplasty (replacement).
As you have discovered, not everyone is a good candidate for a total ankle replacement. Choosing the right patient is as important as selecting the best implant design. The patients most likely to benefit from this procedure are those with severe osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. They have tried and failed with conservative management. They are candidates for ankle fusion called arthrodesis but would like to save joint motion.
Most of the patients selected for ankle replacement are older and less active. They have severe pain from their ankle arthritis. Those with rheumatoid arthritis seem to have the best results so far. Using these implants for younger, more active adults remains a topic that is debated.
For sure, anyone with a large amount of bone loss, infection, or severe deformity won't qualify as a candidate for ankle replacement. Surgeons may carefully screen patients who are obese, have severe ankle instability, engage in heavy-labor, or have poor skin or bone quality. These people may be more likely candidates in the future but right now, they aren't considered good candidates for this procedure.
Surgeons are aware that ankle replacements have improved but still carry a high degree of risk and potential problems even when carried out by an experienced surgeon. Choosing patients carefully, being familiar with the various implants, and knowing how to do the surgery are essential for a successful outcome. The surgeon must plan carefully for individual patient variations in anatomy, alignment, and joint biomechanics.
Praveen Yalamanchili, et al. Total Ankle Arthroplasty: A Modern Perspective. In Current Orthopaedic Practice. March/April 2009. Vol. 20. No. 2. Pp. 106-110.
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