Within the last several years, although around for decades, Total Ankle Replacements have been gaining popularity in both the Podiatric and Orthopedic medical fields as a means of treating chronic ankle arthritis and pain. On the tails of success of the total knee and total hip replacements, used for treating painful hip and knee joints that have become chronically arthritic, technology for total ankle replacements has taken flight.
To many, understanding the science and theory behind total hip and total knee replacements makes sense and it seems as though these procedures have been around for long periods of time. Total ankle replacements have been around since the 1970’s and although they originally gained popularity in Europe, there are currently four Total Ankle Replacement systems that are FDA approved and available for use in the United States of America.
Indications for a total ankle replacement include ankle joints that have reached end-stage arthritis with chronic pain and have not responded to other conservative treatment options. Those ankles most likely to suffer end-stage ankle arthritis are ankles in patients who have a history of ankle trauma (fracture, joint infection, etc) that has led to chronic pain. Conservative treatment options that may be explored prior to consideration of total ankle replacement include joint injections, immobilization, physical therapy, and ankle scope.
In the past and currently, although times are changing, the ‘gold-standard treatment for end-stage ankle arthritis has been ankle fusion. An ankle fusion basically employs a cleaning up of the inside of the ankle joint followed by permanent consolidation of the bones that make up the ankle. The procedure’s end result is a permanent loss of motion at the ankle joint. If you prohibit motion at the ankle joint, or any joint with chronic pain and end-stage arthritis, you eliminate pain. A loss of motion = a loss of pain. However, with ankle fusion procedures, the motion lost (beneficial in the normal gait cycle), requires your body to make adjustments in gait. This inconvenience, for patients suffering from chronic pain and arthritis, is nothing in comparison to the elimination of joint pain, and patients tend to do extremely well post-operatively. However, total ankle replacements aim to preserve ankle joint motion while still eliminating pain.
Preservation of motion while eliminating a patient’s pain would be far superior to ankle fusion, where motion is eliminated. Total ankle replacements are intended to allow the patient to ambulate with “normal” use of their ankle joint. If ankle replacements become the ‘gold standard’ of treatment in treating end-stage ankle conditions, they provide a viable option for patients before consideration of fusion.
Not all patients are candidates for total ankle replacement, so a discussion of all options should be explored with your Podiatrist. In addition, the technology is still expanding, but in the coming years, it looks to be a promising alternative to treating patients with chronic ankle arthritis and pain.