Great Strides in Ankle Replacement (2)

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 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.”