All About Ankle Replacement

In this video Mary Lynn talks about her ankle replacement surgery at UFAI and how she got back on her feet and doing things she loves.


If you suffer from advanced ankle arthritis or a deformity that is not correctable via traditional surgery, ankle replacement may change your life.


Our surgeons are the forefront Ankle Replacement Surgery

We're one of the few centers in the United States that has expertise in all three forms of approved total ankle replacement surgery.


Through our involvement in research and decades of experience, we're truly able to custom design the surgery for each patient.

The Right Patient for Ankle Replacement Surgery

Ankle Replacement Surgery Video
Dr. Baravarian discusses recent advancements in ankle replacement surgery.

In the past 10 years, there has been a dramatic decrease in the number of ankle fusion procedures performed as many ankle arthritis cases are seeing improved outcome with total ankle replacement, also known as total ankle arthroplasty or TAA.


Ankle replacement can be an excellent treatment option for the proper patient, and there is nothing that replaces a surgeon’s experience in making sure the right choice is made. University Foot and Ankle Institute’s combined decades of experience assures you that the decision you make with our doctor will be the best one just for you.


Total Ankle Replacement vs. Ankle Fusion

More today than ever before the question is posed to us -- “will an ankle replacement or a fusion give me the best outcome?” In general, UFAI reserves ankle fusions for the active patients who require a tremendous deal of strength and stability from their ankle. These patients typically participate in very high impact activities or physically demanding jobs that place a great deal of stress on their ankle. Ankle fusions are also preferred for patients with severe angular deformities of the ankle joint, which is usually not correctable with a TAA.


For patients who don't demand quite as much from their ankle, TAA may be a better treatment option.  This includes your average jogger, hiker and walker. Also, the ideal TAA candidate will have little to no angular deformity.  TAA patients that are extremely active and put undo stress on their ankle implant can hinder an otherwise successful procedure.  


Although some level of angular deformity can be corrected with soft tissue and or bone realignment procedures in a separate and prior surgery, the better patient will be one with an arthritic ankle that is well aligned in all three planes. It is interesting to note that those patients who have arthritis in other joints of the foot, (the midfoot and hindfoot), seemingly have more success with a TAA than an ankle fusion.  This is due to the fact that the loss of motion at the ankle with an ankle fusion places greater stresses on the surrounding joints; this may lead to furthering the already arthritic changes of the other joints. 


A TAA allows motion of the ankle resulting in less strain about the already arthritic surrounding joints.


What is the minimum age for a patient considering Ankle Replacement Surgery?

As a general rule, we want to wait until our patient is at least 55 years old to suggest an ankle replacement. Younger patients presumably have many more years ahead of them, which increases the chance of implant failure.

But there have been rare instances where we have considered some patients as early as age 40, but this is highly dependent upon their individual condition in addition to how they live their life. For example, if they are less active and athletic, are not often under a lot of physical or emotional stress and do not perform any heavy manual labor, then their their job and lifestyle might be more suitable to this procedure.

Patient suitability for any procedure is highly individual and that is our approach to foot and ankle care.

Keys to a Successful Ankle Replacement Surgery

The new generation of ankle replacements provides an excellent option in the treatment of ankle arthritis and has proved to be a better option than ankle fusion in the proper situations.


Of greatest importance is proper patient selection. If the highly active, very young patient, an ankle replacement may not be the best option and ankle fusion may work better.  However, in many cases, an ankle replacement allows return of motion, decrease in pain and continued full activity. 


It is important to remember that choosing the right type of device (there are currently three excellent choices) and proper placement of the implant are critical keys to an ideal outcome.


After fully examining your ankle, your medical history and your lifestyle (activity level, physical demands of your work, sports played, etc.) your doctor will discuss with you which option (or options) are best for you.



Ankle Replacement Technologies Offered at UFAI

University Foot and Ankle Institute is one of the only centers in the world to utilize all three of the leading ankle replacement options:

  • The InBone total ankle replacement by Wright Medical, which is a “fixed ankle replacement.”
  • The Salto Talaris-Tornier System is also a “fixed ankle replacement”
  • The STAR Ankle (Scandinavian Total Ankle Replacement) by Small Bone Innovations is a “mobile bearing system.”  

Each technology has slightly different characteristics, as well as advantages and disadvantages.  The determination of which implant is the best for the patient depends on many factors.



Fixed vs. Mobile Bearing Ankle Replacement Technologies

The main difference between a fixed and a mobile bearing ankle replacement is that with the mobile bearing option, the plastic spacer material is not attached to the talar or tibial bone and floats in between the two. This allows for some varus and valgus tilt within the replacement and the joint.  It is suggested that there may be less stress on the joint and the components during movement and weight bearing on the metal-bone attachment point of the implant resulting in less loosening and failure over time.


The fixed option has a plastic spacer that is attached to the tibial component, this does not allow for any varus or valgus tilt but allows for a long stem insertion into the tibia which has been suggested to add strength and prevent subsidence or impaction of the metal into the bone that can lead to failure.



Which Ankle Replacement Technology Is Right for Me?

Ankle replacement surgery, STAR, InBone total ankle replacement

The choice of implant is not a simple one to make. The STAR ankle and the Tornier implant are both very low profile, meaning there is less of the original bone that needs to be removed to allow for the replacement to be placed into the body.  If the replacement was to fail and need to be removed there is then more of a potential to be able to convert to either a fusion or larger ankle replacement. 


On the other hand, the InBone ankle replacement has an excellent implantation guidance system and rig that is used during the procedure that allows for precise measurements and cuts during the surgery.  The long tibial stem that the system uses allows for excellent tibial stabilization of the replacement making it stronger. Both systems have had excellent results and are fairly easy to insert after a learning curve is mastered.


In our institute, we have begun to use the STAR ankle replacement in stable and simple ankle replacement cases, which require minimal soft tissue or boney procedures. The STAR also has a more stable talar component, which we prefer in cases of severe talar arthritic changes or severe medial and lateral gutter arthritis. It is still unclear, however, if there is any major benefit to a three-piece mobile bearing implant.


On the other hand, if there are any cystic changes in the tibia or if there is previous distal tibial fracture and the bone quality is not ideal, we prefer the InBone ankle replacement as it has a far more stable tibial component.  In addition, the InBone ankle replacement has a better surgical guidance system which allows better positioning in more difficult ankles. Finally, in the case of a previously failed ankle replacement that requires revision, the InBone is our preferred system.  In simple cases with no deformity and an older patient with little use of the ankle, the Salto Talaris-Tornier implant is an excellent option.



University Foot and Ankle Institute for Your Ankle Replacement

At University Foot and Ankle Institute, we are proud to be at the forefront of ankle replacement surgery.  Over the past 30 years there has been an enormous amount of research and greater understanding of the biomechanical complexities of the ankle joint. This has led to vastly improved devices, materials and implant placement guidelines. As a result, there have been dramatic improvements in the quality and longevity of total ankle replacements.


If you’re suffering from ankle problems and are unsure of all your alternatives, please contact us today to schedule a consultation.


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