Total Ankle Replacement and Ankle Fusion Surgery

Updated 4/11/2019
Mary Lynn talks about her ankle replacement surgery at UFAI and how ir really changed her life.

 What's Ankle Replacement & Ankle Fusion

 

If you suffer from painful advanced ankle arthritis, ankle deformity or a severe ankle injury, and haven't gotten relief from non-surgical treatments, you have two very effective surgical options.

 

These two options are an Ankle Fusion or a state-of-the-art ankle replacement (also called "Total Ankle Replacement")

 

Both options may dramatically change your quality of life but neither are right for everyone. Learning which one will give you optimal results takes an experienced surgeon as one options is never right for everyone.

 

What’s an Ankle Fusion?

 

Ankle Fusion (also known as ankle arthrodesis) is a surgical option meant to relieve chronic pain and maintain or even improve the function of the ankle for patients that have end-stage ankle arthritis.

 

This procedure take the ankle bones and using specialized pins, screws, plates and bone grafts to permanently join the tibia (or shinbone) to the talus (the bone that makes up the lower part of the ankle joint). The procedure offers pain relief by stopping the painful joint motion caused by the arthritic joint.

 

What’s an Ankle Replacement?

 

Ankle Replacement (also known as "total ankle arthroplasty" or "TAA"), is a considered a gold standard joint replacement surgery used to stop the chronic ankle arthritis pain? Unlike an ankle fusion, TAA is not recommended for people with severe deformity or dead bone in the talus (the bottom bone of the ankle joint), bad blood flow to the area or abnormal nerve function.

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

 

 

 

Total Ankle Replacement vs. Ankle Fusion, Which is Better?

 

More today than ever before the question is posed to us -- “will an ankle replacement or a fusion give me the best outcome and let me finally be pain-free?” Let's answer that question now for you.

 

 

Who's a Good Candidate for Ankle Fusion Surgery?

 

In general, UFAI reserves ankle fusions for the active patients who require a tremendous deal of strength and stability from their ankle without ankle pain. 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.

 

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.

 

 

Who's a Good Candidate for an Ankle Replacement?

Post-surgery x-ray of Wright Infinity Prophecy Implant

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.

 

  • A patient who is active but does not overuse the ankle, such as a person who wants to walk and hike but not play basketball.
  • A patient who is not so young that they will need several revisions over a lifetime as each revision is more difficult than the one before.
  • A patient who is not highly stressful on the ankle at work such as a construction worker and a patient who has a relatively good bone, skin and position of the ankle qualities.

     

    Who's a Bad Candidate for Ankle Replacement?

    An ankle replacement surgery (or an "artificial ankle" as called by some patients) is not right for every patient. The standard list patients who are not good candidates for ankle replacement are:

     

    • Diabetic patient with neuropathy
    • Patient with neuropathy that is severe
    • Patient under the age of 55
    • Patient with very bad skin quality
    • Patient with previous ankle infection history that is not controlled and resolved
    • A patient with bad bone quality
    • A patient rheumatoid arthritis
    • A patient with a high activity level, such as one who plays basketball.

     

    These are the most common list of cases to be avoided. That being said, a diabetic patient with no neuropathy can be a good candidate for surgery as can a patient who is 35, does not want a fusion or would do better with a replacement due to surrounding joint arthritis or pain.

     

    We have created our own list of poor candidate patients. Our list is a little more fluid in some ways and a little more strict in others. Our list of poor candidates includes those with:

     

    • Patients severe neuropathy to the ankle level
    • Patients with bad bone quality or bone cysts
    • Patients with unresolved infection of the ankle
    • Patients with poor skin quality
    • Patients with severe ankle deformity
    • Very young patients


    As you can see, we do not specify an actual level for each of these issues. If you have an infection, we say no. If you have bad skin, we say no. If you have a severe deformity, we say no. That being said, we are somewhat fluid with picking the right patient because we are able to adjust the implant to the patient which gives us more options.

     

     

    The Importance of Picking the Right Ankle Replacement Surgeon

     

    Two groups of foot and ankle specialists perform ankle replacement surgery. One is orthopedic foot and ankle surgeons and the other is podiatric foot ankle surgeons. An orthopaedic surgeon does not always do foot and ankle surgery and not all foot and ankle orthopedic specialists do ankle replacement. Similarly, not all podiatrists do ankle replacements even if they do surgery. In both groups, the first question is to find out if the surgeon does ankle replacement and how often.

     

    The second point is that there are several types of ankle replacement and each one has positives and negatives. We will discuss these later but the second part of finding the right surgeon is to know which ankle replacement options they are trained in and if they do more than one type of ankle replacement. 

     

    This is a critical factor because having a surgeon who has more than one replacement option allows the surgeon to pick the one that is best for each patient.

     

    A UFAI Ankle Replacement Patient Says...

    Albert, injured his ankle playing volleyball in 1964. He tried braces and orthotics but nothing worked. Other doctors told him ankle fusion was his only option. Walking was important to him, so fusing his ankle wasn't something he wanted to do. He came to UFAI and doctors recommended an ankle replacement. He agreed and he’s currently recovering well and very pleased. Read Albert's review here...

     

    5 Star review, University Foot and Ankle Institute

    I am so glad that we found UFAI.

     

    I had lived with a painful and unstable ankle for over 50 years. A orthopedic doctor (specializing in foot and ankle issues) and podiatrists never offered this alternative. I was told I just had to continue to live with this unstable and painful ankle condition.

     

    Thank you for the new ankle. The physical therapy group at the office are awesome as is the entire staff there. I look forward to the coming months when all the therapy and hard work pays off as far as getting all the ligaments working as they need to.

     

      

    Ankle Replacement Options at UFAI

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

    • The InBone Total Ankle Replacement system by Wright Medical
    • The STAR Ankle (Scandinavian Total Ankle Replacement) by Small Bone Innovations
    • The Infinity Ankle Replacement system by Wright Medical

    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.

     

    Understanding Ankle Replacement Options

    Ankle replacement options are currently divided into minimal bone resection low profile implants and greater bone replacement better fixation implants. These two categories are important to understand because each patient will have certain requirements that are best addressed by the differing implants.

     

    Low Profile Implants

    The low profile models, which are the Stryker ankle replacement system and the Wright Infinity are both excellent options for ankle replacement. Low profile requires minimal bone resection (there is less of the original bone that needs to be removed to allow for the replacement to be placed into the body) and the implant is solid and stable with near natural movement.

     

    These implants are excellent for initial replacement options in an ankle without previous ankle replacement and also excellent in an ankle with no major bone loss and no major angulation of the joint or severe deformity of the bone or joint. 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.

     

    The minimal bone resection implants are not ideal for deformed joints, poor bone quality or patients with high demand type jobs who put a great deal of stress on the ankle.

     

    Greater Bone Replacement Fixation Implants

    For revision cases, deformity and poor bone quality about the patients with high demand jobs, the ideal implant is the Wright InBone system. This implant has a longer and more stable stem and is used commonly as a revision system for previous ankle replacements and for deformity correction.

     

    Other Considerations

    It is important to consider is the surgical planning of a case and which implant is best for each type of case. The Wright implants, both infinity and InBone prophecy, can be customized prior to surgery. This system takes a computerized tomoghraphy (CT) of the knee, ankle and foot and assesses the deformity of the knee to toes concentrating on the ankle position.

     

    A custom made ankle cutting guide is then constructed that allows proper bone cuts to be made in order to get ideal correction of the ankle bones and align the implant in the best position possible. This system also decreases the surgery time from 2-3 hours to 1-1.5 hours.

     

    Currently we prefer to use the CT guided ankle replacement systems most commonly as they reduce operating room time and allow for a more custom cutting guide system pre arranged for the ankle. When a CT guided system is used, Wright adds the word Prophecy to the implant system.

     

    Which Ankle Replacement Technology Is Best for You?

    Ankle replacement surgery, STAR, InBone total ankle replacement

    For low profile settings, we use the Wright Prophecy Infinity system. This is an outstanding system and very low profile. Stability is solid as long as there is no major deformity and bone quality is good.

     

    If the ankle is very stiff and we want to get a little added motion, the Stryker system, which is mobile bearing, allows a little more motion and is used in low profile settings with good bone quality and no major deformity.

     

    If there is major deformity or the bone quality is not idea or the replacement is a revision, we usually will go to the InBone Prophecy system from Wright. This system has great bone purchase and allows better deformity correction.

     

    In cases of poor skin quality on the front of the ankle, we can use the Zimmer system which places the implant from the side of the ankle. Although more difficult, we can use this option to avoid further damage to the front of the ankle if there has been a lot of previous trauma to the region.

     

    With proper planning, ankle replacement can be one of the most amazing experiences for a patient and dramatically improve the quality of a person’s life.

     

    UFAI, the Best Surgeons for Ankle Replacement Surgery

    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.

     

    Ankle replacement technology aside, there's 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.

     

    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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