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One of the most exciting surgical developments to emerge in the last decade is a dramatic improvement in total ankle replacement surgery. Most people are not familiar with this procedure or this option for ankle pain. Knee and hip replacements have been a familiar procedure for many years.
The first total ankle replacement procedure, was introduced back in the 1970s.The original design of the ankle replacement was not very successful due to the ball and socket type prosthesis. This resulted in subsidence and instability. As technology and our understanding of the working components improved, the results of these implants improved.
Over the last 5-10 years ankle replacement surgery now demonstrates results that are equivalent and many times superior to a fusion procedure. This is now becoming the new wave of treatment for ankle arthritis. The newer implants use a mobile-bearing joint that reduces stress on the ankle joint itself. With these improvements the ankle implants are holding up to the rigorous demands placed on this joint.
Patients that suffer from osteoarthritis, post-traumatic arthritis, avascular necrosis, and rheumatoid arthritis now have a great option for treatment. Previously the “gold standard” for these patients was a fusion procedure. With this came several disadvantages which included limping due to restricted ankle motion and stress loads transferred to adjacent joints leading to arthritis. With an ankle joint replacement, patient’s are able walk with a more normal gait cycle with elimination of their ankle pain. Patients are now able to return to relatively normal functional capacity after surgery.
Currently there are 8 FDA approved ankle implants: Agility (Depuy), InBone and Infinity (Wright Medical), Salto-Talaris and XT (Integra), Cadence (Integra), STAR (Stryker) and the Zimmer Trabecular Medal Total Ankle. Each of these implants offer distinct benefits that should be selected based on specific patient criteria. Typically this procedure takes approximately 1-3 hours to complete followed by an overnight stay in the hospital. Many patients however can go home the same day of surgery. Patient’s are usually kept non-weightbearing for 3-6 weeks following surgery, and at that time may begin walking on their new ankle.
At this time this procedure is being offered by TPMG Orthopedics and Sports Medicine. We have performed the first total ankle replacement surgeries at Sentara Williamsburg Regional Medical Center, Riverside Doctor’s Hospital, and Bon Secours Mary Immaculate Hospital. Since that time in 2011 we have performed this procedure on patients from all over the east coast and have become a destination for excellence in total ankle arthroplasty.