Q1. Who should have an ankle replacement?
One should consider having an ankle replacement when there is severe arthritis of the ankle, with the pain from the ankle resulting in a limited ability to walk. Patients should have no infection, skin in good condition, and be approximately 55 years of age or older unless there are special circumstances.
Q2. When is the right time to have an ankle replacement?
The right time to have an ankle replacement is when the ankle is becoming painful enough that walking a few city blocks is difficult. In other words, aside from scheduling, this is a pain and function-related decision. The more pain and limitation you have, the easier the decision is to have an ankle replacement. Patients with mild pain and good function should wait as it’ll make the decision easier. Patients with very limited function and real pain should strongly consider the procedure.
Q3. What type of ankle replacement?
At this time, there is no consensus as to what is the best design for an ankle replacement. For example, the ankle replacements presently on the market vary much more in design than the design of hip or knee replacements. Just take a look at a few examples of the common ankle replacement. Although this is not an exclusive list, these are the Salto Talaris, the Infinity and INBONE replacements, the Zimmer Trabecular Metal ankle replacement and the STAR. I am a part of a team who developed the Zimmer ankle replacement. However, I have used the different types of ankle replacements. Also, at HSS, we are studying the different types of replacements and continue to use different types depending upon the situation. There is no one type best for all ankles. The success of ankle replacements is a relatively new development with not nearly the number of years for designs to converge as has happened to a large extent with hip and knee replacements. Further study on how patients are doing with the different designs over the long-term needs to be done.
Q4. What are the long-term and short-term problems for ankle replacements?
As with other joint replacements, the long-term problems to ask about are the loosening of the implant, subsidence, or sinking in, of the implant into the bone and development of cysts or loss of bone around the implant. Short-term problems include bony impingement in the areas of the ankle not replaced by the replacement (medial and later gutters) and normal risks of surgery such as infection, wound problems, numbness or nerve pain. Incidences of these are small.
Q5. Are there any further developments in ankle replacements?
There are different designs that will be coming out on the market. Important goals when discussing future ankle replacements are to take less bone, the longevity of the replacement (minimizing loosening and subsidence) as well as allowing good motion of the ankle.
Dr. Jonathan Deland, Foot & Ankle Surgeon, is the Co-Chief of the Foot and Ankle Service at Hospital for Special Surgery. He is a recipient of an NIH Grant on Posterior Tibial Tendon Insufficiency, which he initiated the creation. Dr. Deland also has a special expertise in foot and ankle sport injuries, acute and chronic Achilles ruptures/tears, and is the co-developer of the Zimmer Total Ankle Replacement.