Question:Ten years ago, I looked into having an ankle joint replacement for my arthritis. Back then, there were too many problems with the implants. I'm still gimping around with my painful, limited ankle. Are things any better now that I should consider this again?
Answer:Treatment for ankle osteoarthritis has expanded over the years. In addition to debridement, cartilage transplantation is now an option. Debridement is the removal of bone spurs and smoothing uneven joint surfaces. The procedure can be done arthroscopically, avoiding an open incision.
Cartilage transplantation called allograft arthroplasty has great potential. By replacing damaged cartilage with fresh graft material, arthritic joints can be restored to a more normal joint surface.
Despite these advances in treatment for ankle osteoarthritis, ankle fusion is still the most common surgical procedure done for severe, painful ankle arthritis. But studies show that long-term results of fusion aren't as good as expected.
Although the patient gets relief from pain, over time, adjacent joints start to break down. Pain and disability are the natural result of this process. And, of course, fusion means a loss of motion, which often means a loss of function.
The use of ankle implants is on the rise. The implants were first developed in the 1960s. Since that time, many changes and improvements have been made in design and materials. Third-generation total ankle arthroplasty (TAA) is now being investigated.
Third-generation refers to the third round of new and improved implants. Minimal bone resection makes it possible to use these implants with patients who have weak bones. Using the patientâs own ligaments helps stabilize and balance the ankle.
Results of TAA are good so far. There's about an 11 per cent revision rate but a much higher rate of loosening (76 per cent). Delayed union is common, taking as much as six months or more to fully heal. Even with these problems, more than 90 per cent of the patients report decreased pain and a high level of satisfaction with the results.
If you haven't been evaluated by an orthopedic surgeon in the last 10 years, an orthopedic examination is your first step. Discussing all the pros and cons of the implant procedure may help you make the decision.
Patients are selected carefully to ensure success. You'll want to find out if you are still an acceptable candidate for TAA. If not, there may be other treatment options that can help reduce painful symptoms and preserve function.Loretta B. Chou, MD, et al. Osteoarthritis of the Ankle: The Role of Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. May 2008. Vol. 16. No. 5. Pp. 249-259.
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