New York, NY—June 23, 2014
Arthritis can cause terrible pain, making activities of daily living difficult, if not impossible.
Although ankle fusion traditionally has been the standard treatment, improvements in implant design have prompted more orthopedic surgeons and their patients to consider ankle replacement to relieve pain and restore function, according to Jonathan Deland, MD, co-chief of the Foot and Ankle Service at Hospital for Special Surgery in New York City.
"In ankle replacement, we replace the damaged surfaces of the ankle joint with an artificial implant," explained Dr. Deland. "One of main the advantages of ankle replacement is that it provides patients with better movement and mobility compared to ankle fusion, in which bones in the ankle are fused together using metal screws."
In addition, ankle stiffness resulting from fusion puts stress on other joints in the foot, leaving an individual more susceptible to arthritis in those joints.
The newest implant used in ankle replacement, which Dr. Deland helped design with other doctors, is considered by many to be an advance over previous models. "It is designed to better reproduce the ankle's natural motion. It is also designed to be longer lasting. It has the proper curvatures like a normal ankle," he explains.
The new implant was good news for 61 year-old David Sander, who suffered a broken ankle 30 years ago and later developed severe arthritis. The Asbury Park, New Jersey resident said he put up with the pain for years because he wanted to avoid ankle fusion and was not convinced the ankle implants available at the time would allow him to return to activities he had abandoned because of the arthritis.
When Dr. Deland told him about the new implant, which was approved by the FDA in 2012, Mr. Sander opted for ankle replacement surgery with the new prosthesis. "Before the surgery, I could barely walk. I was in constant pain," he said. "After ankle replacement, I got my life back. The pain is gone. I go bike riding, walk on the Boardwalk, I go camping and hiking in the woods. Everything that had been taken away from me has been given back."
Mr. Sander says his ankle now feels normal and he even forgets he has an implant. Components of the prosthesis work together to restore the natural movement of the ankle joint, according to Dr. Deland.
The surgical technique used with the new prosthesis entails an incision on the side of the ankle, as opposed to one in the front used for traditional implants. "The side incision will generally cause less disruption to the soft tissues surrounding the ankle joint and allows for the replication of curved bone surfaces like those in a normal ankle," he says.
Candidates for ankle replacement are people with severe pain for whom conservative treatments, such as rest, pain medication and bracing fail to provide relief. Eligible patients are at least 50 years old, they must have good bone quality and foot alignment, and they cannot have any underlying health problems that would impede healing, according to Dr. Deland.
When considering ankle replacement, Dr. Deland stresses the importance of choosing an orthopedic surgeon with significant experience. "No surgeon should do only one or two of these procedures per year – they'll get into trouble mighty fast," he says. "You have to know about foot alignment, and you have to know the implant. Studies show a steep learning curve when performing total ankle replacements."
The surgery is covered by Medicare and most insurance companies.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.