Ankle Replacement Surgery Improves Range of Motion and Quality of Life

ankle arthritis, ankle replacement, ankle surgeon los angeles

No doubt about it, end-stage ankle arthritis sounds scary. But the reality is even worse than it sounds. When the protective cartilage that cushions the ankle joint is lost, bone grinds on bone. The results? Debilitating pain, major disruption of ordinary activities, and a steep decline in ones quality of life.

50,000 new cases of ankle arthritis occur every year, and many eventually deteriorate into an end-stage condition.

Until recently, fusion of the ankle joint was the standard treatment for end-stage ankle arthritis. Replacement of the entire ankle joint (total ankle arthroplasty, or TAA) was a distant second. But TAA technology and techniques have made huge improvements in the last decade.

The architecture of the ankle joint is under appreciated

The ankle’s impressive functional capacity deserves more recognition. It works like a hinge that enables bending and twisting in three directions, sometimes simultaneously. Anklesmust be both strong and stable, because it bears 150% of your body weight when you walk.

​That load goes up to 800% of your body weight when you run. And the ankle must instantly adapt to whatever terrain you’re traversing.

Three-dimensional models of the ankle reveal a mechanical appearance. Two bone structures (the talus and the calcaneous) link the leg bones to the foot bones. The whole apparatus is strapped together with strong cords made of collagen. Ligaments attach bones to bones. Tendons attach bones to muscle. Sturdy straps and buckles would not look out-of-place on the human ankle joint.

The portions of the ankle joint which rub against each other are covered with a quarter inch or so of cartilage (a fibrous material also made of collagen). This layer of cartilage provides a lifetime’s worth of shock absorption and friction elimination.

Loss of cartilage turns ankle arthritis into an “end-stage” condition

End-stage ankle arthritis occurs when repetitive trauma, or the inflammatory autoimmune disease known as rheumatoid arthritis, erodes the protective cartilage. The ankle bones are left bare, with no alternative other than to rasp against each other. This limits range of motion and causes excruciating pain. Everyday activities become hard to bear. Even getting out of a chair can become difficult.

What are the conservative approaches to healing ankle arthritis?

Non-surgical treatments include medication, lubricating injections, physical therapy, dietary changes, and bracing. They often provide a level of relief. When they fail, the patient/surgeon team can review several surgical options.

Fusion of the ankle joint was once standard treatment

Ankle Replacement Surgery Options, University Foot and Ankle Institute, Los AngelesSurgical immobilization of the ankle joint, called arthrodesis or fusion, has been the standard treatment for end-stage ankle arthritis. In a fusion surgery, screws, plates, nuts, and bolts are assembled into a structure, then implanted in the ankle. This mechanism compensates for the missing cartilage by permanently separating the leg bones (tibia and fibula) from the upper bone (talus) of the ankle joint.

Fusion can still be the best choice for very active patients who value ankle strength over ankle flexibility. Patients whose work, hobbies, or sports participation frequently impose high stress levels on their ankles often prefer fusion.

​Fusions are also appropriate for patients with severe deformities of the ankle joint.

But even the most successful fusion eliminates any flexibility from the ankle. This means that the pressures which a normally flexible ankle would routinely absorb are instead passed on, through the fused ankle onto the adjacent bones and joints.

​These increased forces can initiate new arthritis in those areas.

Total replacement of the ankle joint comes into its own

The technology of total ankle arthroplasty (TAA), or total ankle replacement surgery, has significantly advanced in recent years. When technological progress and enhanced surgical techniques join forces, the results nearly duplicate normal ankle function.

Instead of fusion’s permanent paralysis of the ankle joint, TAA replicates the structure and function of a normal ankle. This enables restoration of a normal gait and avoids the limp which often accompanies fusion. More importantly, a modern ankle replacement device absorbs the impacts created by normal activity.

​This protects the midfoot, hindfoot, and knee joints from the threat of transferred end-stage arthritis.

A new study confirms the benefits of total ankle replacement

A study recently published in The Journal of Bone and Joint Surgery reported on the results of 134 total ankle replacements. The researchers assessed the patient’s range of motion, pain levels, and ability to complete everyday activities before the surgery.

​They followed the patients’ post-surgical progress at intervals of three months, six months, one year, and two years after surgery.

The results are more than impressive. In the first 6 months, the surgery improved the patients’ ankle range of motion by an average of 66 percent. Over the two-year period, the patients’ pain scores fell from 74 on a 100-point scale to 15. Their ability to perform ordinary tasks rose from 50 to 80 on a scale of 100.

The results of this study remove any doubt. Total ankle replacement is a proven life changer for people with end-stage ankle arthritis.

Keys to a successful ankle replacement surgery

“One of the most important issues to consider is proper patient selection and picking the right implant for the right patient,” says Dr. Bob Baravarian. For highly active, very young patients, who place a great deal of stress on their ankles, an ankle replacement may not be the best option.

​For those patients, ankle fusion may still be the better choice. But in most cases, ankle replacement improves the range of motion and decreases pain. Over time, the TAA patient enjoys an improved quality of life as ordinary activities are fully resumed.

University Foot and Ankle has mastered total ankle arthroplasty

Ankle Replacement Surgery, Wright Infinity Prophecy

Post-surgery x-ray of Wright Infinity Prophecy Implant. This is considered an ankle resurfacing more than a replacement because such little bone is removed.

Choosing the right type of ankle replacement device (there are currently three excellent choices) and proper placement of the implant are critical keys to an ideal outcome.

Since the advent of second and third generation TAA devices, the podiatric surgeons of University Foot and Ankle Institute have acquired the knowledge, training, experience and skill required to elevate UFAI to the highest rank of total ankle arthroplasty providers Indeed, Dr. Baravarian and Dr. Franson both educate other podiatric surgeons in the science and art of TAA.

UFAI’s surgeons are expert in each of the three leading ankle replacement options:

  1. The InBone Total Ankle Replacement system by Wright Medical
  2. The STAR Ankle (Scandinavian Total Ankle Replacement) by Small Bone Innovations
  3. The Infinity Ankle Replacement system by Wright Medical

We can help

If you are experiencing the agony of end-stage ankle arthritis, our doctors are here to help. Each ankle replacement option has slightly different characteristics. The determination of which implant is the best for you depends on many factors.

​After fully examining your ankle, your medical history, and your lifestyle (your activity level, the physical demands of your work, the sports you play, etc.), you and your doctor will determine which option is best for you.

The nationally recognized foot and ankle specialists of UFAI offer the most advanced available foot and ankle care, together with the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation, please call (877) 736-6001 or visit us at

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