Total ankle replacements have increased exponentially in recent years because of the advancement of technology, and they are providing more natural movement. Beginning in the 1970s, it took decades to improve implant devices and perfect protocols due to the complexity of the ankle joint. The first real successes were seen in the late 1990s. In 2007, about 290 total ankle replacement surgeries were performed in the country. By 2014, that number increased to almost 4,500.
Dr. Geoff Watson is with us today to discuss total ankle replacement surgery available at Bone and Joint Institute of Tennessee. He is a board certified orthopaedic surgeon, specializing in treatment of the foot and ankle. After completing his residency at University of Mississippi Medical Center, he completed a fellowship in foot and ankle at the Hospital for Special Surgery in New York, New York. During his training there, he assisted in the orthopedic care of the New York Knicks and the New York Giants.
Williamson Source: Thank you for helping us provide our readers with knowledge about total ankle replacement surgery. Can you describe what happens during the surgery?
Dr. Watson: Ankle replacement surgery is like hip replacement surgery in that one removes a segment of painful damaged bone and replaces that with metal and plastic. Years of repeated sprains and trauma, including ankle fractures, can lead to post traumatic arthritis, which in turn can cause bone spurs and other damage initiating massive pain. If the pain and loss of movement become too severe, and all other treatment options have been employed without success, total ankle replacement surgery becomes the most reliable treatment option.
WS: There are a number of types of ankle replacement technology, what are the different types?
Dr. Watson: STAR Total Ankle was the first to allow ankle replacement implants to become approved by the Food and Drug Administration. Their implant has a different design than most of the other producers in that the tibial plate and the talar component allow for movement with the plastic liner. It gives both side to side and up and down motion.
Vantage, Infinity and INBONE Total Ankle Replacement Systems have a plastic piece that snaps into the metal apparatus that is attached to the tibia. This system offers up and down movement, but no side to side movement.
INBONE offers a longer stem which provides more stability, especially for those who have significant deformity about the ankle .
Both Infinity and INBONE provide what is called the Prophecy System. Through this system, implant guides are custom made for each patient using 3-D printed models created from CT scans of the patient’s leg and foot from the knee down. This allows for appropriate selection of implant size before surgery. The guides also use the CT scans to allow for better placement of the implant with respect to alignment. The better the alignment, the less wear and tear on both the implant and the surrounding tissue after placement.
WS: What is the recovery time?
Dr. Watson: For the first three weeks after the surgery, the patient cannot put any weight on their ankle. During the next three weeks, they are slowly allowed to put more and more weight on their new ankle. Patients can typically put full weight on their leg at 6 weeks. In three months, it will be about 80% healed, but it may take a full year to feel normal again.
WS: What is the age of your typical patient?
Dr. Watson: An ideal patient is 55 or older, and the surgery will most likely last the rest of their life. If the patient is younger than 55, a second surgery later in life may be necessary, which may be more complicated.
WS: Are there other options instead of total ankle replacement?
Dr. Watson: Ankle fusion is one option that has been employed for many years. However, it only offers 20 degrees range of motion, and in 20 years the patient’s ankle will be very stiff. When compared to ankle fusion, total ankle replacement is less likely to wear out and stress joints around the ankle, but it is fairly new and studies are evaluating this theory.
Another option is arthroscopic debridement. This surgery implants pins in the foot to hold a frame that will immobilize the ankle and distract the space between the bones of the ankle joint. After damage is removed between the ankle joint bones, scar tissue takes its place. While the scar tissue is developing, the frame must remain in place. While it can be used on younger patients, it is inconvenient and few can tolerate wearing a frame on their foot for 6 to 12 weeks.
WS: Tell us about the new technologies you are using in total ankle replacement?
Dr. Watson: The most important part of the ankle replacement procedure is alignment. It should be perpendicular to the bone. When we do a CT scan, we can see the state of the ankle, including all of the damage we will need to remove. That will dictate the type of implant we will need to use and how we will need to place the implant to ensure long term stability and mobility. This increased accuracy improves the life of the implant, and quality of life of the patient.
If you are suffering from ankle pain and swelling, contact the Bone and Joint Institute.
To learn more about total ankle replacement surgery or ankle and foot care, contact Dr. Geoff Watson at (615) 791-2630 or schedule an appointment online.
