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Extremities Feature

Courtesy of Stryker Corporation

Ankle Replacements Improving But Still Lags

Biloine W. Young • Wed, November 15th, 2017

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An ankle injury presents a problem not only to the individual who experiences it, but also to the surgeon who attempts a repair.

According to Eric Pravin, writing for The Washington Post’s Health and Science section, many surgeons discouraged patients from getting a procedure called an ankle arthroplasty—because of persistent controversy over the earlier surgical techniques. These involved cementing metal ankle reconstruction devices to bone. Sometimes the parts loosened prematurely or caused infections, leaving patients worse off than they had been before.

When surgery was not a realistic option for a patient, doctors prescribed anti-inflammatory drugs and pain relievers. In some situations they recommended ankle fusion surgery which involved the use of screws, plates and bone grafts.

Today many orthopedic surgeons are performing total ankle replacements. They cut away bone and tissue to make space for metal and plastic implants. The procedure has taken 20 years to develop but, according to Pravin, it is highly effective at relieving arthritic pain. To a great extent, patients are able to regain the use of their ankles.

Previn credits this turnabout in medical treatment to the development of implant devices that were approved by the Food and Drug Administration in the early 1990s. These devices—made of metal alloy and plastic—cover both the major shin bone and the ankle bone and are engineered to interact with each other and the patient’s body to maximize mobility and flexibility.

Surgeons have also made great strides in developing techniques that make certain that the implants, once installed, do not wander for many years from where they were placed.

Selene Parekh, M.D., a foot and ankle orthopedic surgeon at Duke Health in North Carolina said, “It is critical to make sure the ankle is balanced so that it has no unusual stress on it. Just like a new set of tires, if they are installed with an alignment issue on the car, they will wear out quickly. This is the same analogy that goes to an ankle replacement.”

Despite all of the improvements, the long-term success with total ankle replacement is not as high as they are for knee and hip replacements. The surgery remains more challenging and risky than other types of procedures.

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