Ankle Replacements On the Rise

Some orthopedists have deemed it the “forgotten joint.” But there just may be a bit of truth to that moniker.

The ankle is one of the more complex joints of the human body, even though it is comprised of only three bones—the tibia, fibula and the talus. These bones (as well as the three groups of ligaments that support them) and the foot log about 1,000 miles every year. They also help cushion up to 1 million pounds of pressure during a strenuous 60-minute exercise session.

Like any joint, the ankle is susceptible to arthritis, and at times, needs to be replaced. Yet such replacements historically have been overshadowed by similar procedures in the hip and knee. Earlier this month, however, ankle replacement surgery took center stage at the Annual Scientific Conference of the American College of Foot and Ankle Surgeons (ACFAS) in San Antonio, Texas.

Participants in a March 2 session learned that ankle replacements in the United States more than doubled last year due to advancements in implants. “In the past, the gold standard for treating these problematic patients was a fusion, or arthrodesis, in which the joint is removed and the bones are fused, thereby taking away the pain but also rendering the ankle immobile,” said Robert Mendicino, D.P.M., F.A.C.F.A.S., a fellow member of ACFAS and a foot and ankle surgeon in North Carolina.

“I believe we’ll see fewer fusions and more ankle replacements in the future with more implants currently available and FDA-approved,” he added. Four ankle prostheses currently are available for implantation, up from just one in the late 1990s. These new implants often have improved designs and include highly precise cutting guides and jigs that help surgeons achieve better alignment and reproducible results.

The typical ankle replacement patient is between the ages of 40 and 60, though older people who are “physiologically young” may be good candidates. Many of these older patients are baby boomers who want to enjoy an active retirement.

Nicholas Abidi, M.D., who founded Capitola, Calif.-based Santa Cruz Orthopaedic Institute in 2000, has experienced a 50 percent increase in ankle replacements over the last two years.

“Ankle replacement technology has definitely improved over the last decade, and surgeons can achieve more reproducible results,” said Abidi, who specializes in lower extremity reconstruction. “This is contributing to increased numbers of active baby boomers opting for replacements to stay active.”

The two-hour arthroplasty procedure involves removing arthritic bone and cartilage from the tibia (leg portion of the ankle) and talus (foot portion). The implant usually consists of two metal components and a plastic spacer that fits between those metal components. The parts are then inserted into the area to form a new ankle joint, according to ACFAS data.