Ankles Gain as Candidates for Joint Replacement

The New York Times—new York, NY—January 18, 2010

The bodies of many older Americans are practically bionic: more than 770,000 hip and knee replacements are performed each year in the United States.

Now another aging joint is fast becoming a candidate for replacement. This year, 4,400 patients are expected to undergo surgery to replace arthritic or injured ankles with artificial joints made of metal alloys and lightweight plastic, according to industry estimates.

Four models are commonly used in the United States, with Food and Drug Administration approval. And demand is expected to grow as more and more baby boomers hobble into their 60s and 70s with debilitating ankle pain.

Dr. Jonathan T. Deland, chief of the foot and ankle service at the Hospital for Special Surgery in Manhattan, said that while the devices had improved, he remained cautious about offering the operation. (Dr. Deland is helping to develop a new ankle replacement device for Zimmer of Warsaw, Ind., which may be submitted for F.D.A. approval this year.)

“The big concern about ankle replacement is how often do they fail and how often do they loosen,” he said.

Complications can include slow healing, as well as infection. Severe complications are rare, but they can result in amputation. Still, Dr. Deland said, “we’re getting fewer and fewer failures.”

The new models require that less bone be removed, so the bone to which the device is affixed is stronger. In addition, instruments used to guide surgeons in aligning the artificial joint have improved. Dr. Deland cited data showing that for some recent models, 90 percent of ankle replacements were still in place after an average of eight and a half years.

Though the four devices in common use have technical differences in design and in how they are implanted, doctors say the choice of device matters far less than the experience of the surgeon. The procedure is among the most difficult that foot and ankle surgeons perform, and one of the biggest challenges is getting proper alignment of the replacement joint.

Read the full story at nytimes.com.