When should you consider joint replacement for ankle pain?

Stock photo by Esther Max via Flickr, St. George News
FEATURE — Most people know someone who has had a hip or knee replacement after suffering from arthritis. That’s because joint replacement surgeries are one of the most common procedures performed in America today.

Fortunately, almost all those who have arthritis and receive a joint replacement surgery experience relief from chronic pain and their quality of life improves tremendously.

A less common but equally debilitating form of arthritis occurs in the ankle, an essential joint required to walk properly. A fractured or severely sprained ankle is common and usually heals without problems, but a small percentage of people with these injuries go on to develop post-traumatic arthritis.

“The effects of post-traumatic arthritis can affect a person’s ability to remain active and even perform regular daily activities,” said Dr. Aaron O’Brien, a foot and ankle surgeon with Revere Health Coral Desert Orthopedics, said. “Our goal is to help patients regain as much of their mobility as possible.”

Treatment options for end-stage ankle arthritis were historically limited to bracing and injections or joint fusion – or arthrodesis.

O’Brien explained that although fusion of the joint eliminates most of the pain, it also reduces overall motion and can cause subsequent arthritis in surrounding joints that now take on more stress. Depending on the age at which the fusion is performed, more surgeries may be needed to alleviate new arthritic problems of the foot.

Over the last 10 years, another viable option has emerged: ankle replacement surgery. Similar to hip and knee replacements, this surgery eliminates the arthritic joint and replaces it with prosthetic components made of metal and plastic. Early attempts at this surgery more than 30 years ago resulted in a high failure rate and poor outcomes. Surgeons quickly abandoned this option and gave it a bad reputation.

“Now with improved implant design, higher quality components and a better understanding of anatomy, ankle replacements have become increasingly popular with higher satisfaction and improved quality of life compared to a fusion,” O’Brien said.

O’Brien also explained recent technologies have helped reduce technical challenges and improve alignment issues that led to failures in the past. All patients undergoing this surgery receive a CT scan, which is sent to specialized engineers. They then create instrumentation specific to the patient’s anatomy. This increases precision during the surgery and ultimately leads to less complications and improved overall function.

Although ankle replacement surgery helps eliminate arthritic pain and improve one’s life, it is not for everyone with ankle pain.

Typically, we reserve joint replacement surgeries for patients in their 60s and older,” O’Brien said. “Also, the supporting structures like ligaments and tendons surrounding the ankle must be intact and functioning properly.”

People can often avoid or postpone this surgery with the use of other treatment modalities such as bracing, therapy, medications and injections. If these treatments fail, you and your orthopedic surgeon can make an educated decision to determine if a joint replacement surgery is right for you.

As the only foot and ankle fellowship trained, board-certified orthopedic surgeon in Southern Utah, O’Brien said he has performed ankle replacement surgery many times. He said:

I am impressed each time I see these patients back with the lack of pain and the improved ability to walk. It is not uncommon for me to get comments like, ‘I am so much more active now and I’m able to enjoy the activities I’ve been wanting to do for years’ and ‘Since my ankle replacement, not only does my ankle feel better but my knee, hip and back have stopped hurting as much too.’

Although most people have not heard of ankle replacement surgery, it is an excellent and reliable treatment option for those suffering with debilitating end-stage ankle arthritis.


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