Can you give me a quick run-down on the status of ankle replacements these days? Last time I checked, our local surgical center and the surgeons there steered me away from an ankle replacement in favor of a fusion. I wasn't ready for that. It's been quite a few years since that time. So now I'm doing a little Internet research before going back for a second opinion.

In a recent review and published update, orthopedic surgeons at Duke University Medical Center take a look at the results of ankle joint replacement. The procedure is called total ankle arthroplasty or TAA. They present a thorough examination of all aspects of TAA from studies published and evidence gained so far on this topic.

Total ankle arthroplasties have been around long enough now to be in what is referred to as second-generation implants. Second-generation means the original design has been improved and changed in a significant way. Along with improved implants come better surgical techniques and surgical tools.

Based on their review of current published analyses of total ankle arthroplasties, the authors of this report give a C grade of recommendation for the treatment of end-stage ankle arthritis with TAA. A C grade means the evidence is of poor quality and conflicting. Does this poor grade mean no one should get an ankle joint replacement?

No -- a closer look at the details of various studies still gives some good information. But the need for better study designs and comparisons is pretty clear. Here are a few of the observations the authors made as they summarized study findings.

  • Implants last up to 12 years so far in 95 per cent of the patients. Younger age (less than 50 years old) and higher activity level may be linked with risk of implant failure.
  • As with other types of joint replacements, loosening and subsidence (sinking down into the bone) are the two most common problems.
  • There isn't one brand of implant that has tested superior to all others.
  • Patients often still experience some ankle pain after an ankle joint replacement. The reason(s) for this remain unclear.
  • Technical errors are more common as the surgeon is first learning to perform this surgical procedure. Complication and revision (second surgery) rates are higher and implant survivorship is lower for patients when the surgeon is new to this procedure.
  • Active adults can expect to return to light recreational sports and activities. Hiking, biking, and swimming seem the most popular activities. High impact or strenuous activities are not advised.

    There are different types of implants available. The one that might best suit you may depend on the type of arthritis you have (e.g., inflammatory, post-traumatic, osteoarthritis), your age, and your activity level.

    Look for a surgeon and surgical center with a high-volume of ankle joint replacement procedures. The expertise gained during the learning curve will reduce the risk of problems and complications possible with ankle joint replacement.

  • Reference: 

    Mark E. Easley, MD, et al. Results of Total Ankle Arthroplasty. In The Journal of Bone and Joint Surgery. August 2011. Vol. 93-A. No. 15. Pp. 1455-1468.

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