Great Strides in Ankle Replacement
Like arthritis in any joint, ankle arthritis causes pain,
stiffness and swelling. However, the symptoms are often more severe in the
ankle because it is the smallest weight-bearing joint. In order to walk, the
small surface area of the ankle joint must absorb the body’s entire weight –
exponentially more pounds per square inch. If the joint is arthritic, each step
can be excruciating.
Foot and ankle surgeons at CHRISTUS St. Patrick Hospital are
now offering new hope for people suffering from this debilitating condition. A
new generation of ankle replacement, the Infinity system is restoring pain-free
mobility for local patients.
Dr. Tyson Green with Imperial Health’s Center for
Orthopaedics explains that ankle arthritis often occurs after an injury, but
can also result from other conditions such as degenerative joint disease,
rheumatoid arthritis, ankle instability, and more. Whatever the cause, the result
is chronic inflammation and degeneration of the cartilage which make up the
cushioning in the joint. "This is very painful, and the condition is permanent;
cartilage does not grow back,” says Dr. Green.
Conservative treatment for ankle arthritis includes bracing, orthotics,
anti-inflammatory and pain medications, cortisone injections and activity
modifications. If these conservative treatment approaches don’t provide relief,
ankle fusion was the only surgical option. "In an ankle fusion, the bones making
up the ankle joint are fused together to form one bone, resulting in no motion
at the joint, and therefore no pain. The down side however is the same – no
motion – which leads to altered gait and problems in other joints, and difficulty
walking on hills or other surfaces, etc. While ankle fusion remains a good
choice for certain patients, there is finally a viable alternative for many –
total ankle joint replacement.”
Dr. Green says ankle replacements have been around for decades, but
until now, have provided unacceptable results. "The smaller size and increased
load on the ankle, as well as more complicated range of motion and difficulty
to access surgically, make the design of an implant very challenging. The early
designs were so bad that even though we were trained in the procedures, Dr.
Kalieb Pourciau and I would not even consider using them for our patients.”
The new Infinity system offers dramatic improvements, including the only
patient-specific, customized CT-guided ankle replacement technology. "The combination of better materials with
advanced design technology give us an ankle replacement that reproduces more normal
ankle motion and helps the joint resist wear over time,” says Dr. Green.
The Infinity’s instrumentation was designed in such a way
that the implant could be placed more accurately in the joint, a process that
is improved by the CT-guided system.
This improved precision results in a significant reduction in operative
time under anesthesia, which decreases the risk of complications.
The ankle replacement procedure itself takes approximately
two hours, with a two-to-three-day hospital stay. Once discharged, patients
remain non-weight bearing in a splint, cast or boot for six weeks. Then they
will begin bearing weight in the boot and attending physical therapy for the
necessary amount of time.
Dr. Green says the majority of patients who undergo ankle
replacement report an immediate decrease in pain which lasts indefinitely. Most
also report an increase in range of motion and improved function. They
typically return to light forms of exercise such as walking, hiking, golf,
cycling, low intensity weight training, yoga and swimming.
Traditionally, ankle implants were not recommended for
patients younger than 50 and above 250 pounds. However, Dr. Green says the
improvement in the technology available with the Infinity is for expanded
indications. "We also consider the patient’s overall health, desired post-operative
activity level and occupation. The decision to have this surgery is one we
discuss and make together with the patient.”