More than two million Americans seek treatment for ankle pain from arthritis or fracture each year.
In the past, their only option for treatment was ankle fusion surgery, a procedure that often leaves patients with very limited mobility. But now more orthopedic surgeons are offering relief to patients in the form of ankle replacement surgery.
On January 26, 2010, Shore Memorial Hospital Surgeon Dr. Ira Fox performed the first ankle replacement surgery in the hospital’s history.
Unlike hip or knee replacements, which have become fairly common, total ankle replacements are more difficult to undertake due to the nature of the joint. The procedure is only performed in a handful of places in the tri-state area.
“(The ankle) is a smaller joint with a smaller surface area, but it has more forces going through it than the hip or the knee,” says Fox, who also practices with Shore Orthopaedic University Associates in Somers Point. “So there is more torque and more degrees of motion in an ankle to be concerned with.”
Fox had performed the surgery several times before at another hospital, but he expressed unhappiness with the results due to the prosthetics he used at the time.
For his surgery at Shore Memorial, Fox used the INBONE Total Ankle System, created by Wright Medical Technology, Inc. After a lengthy evaluation of the prosthesis, Fox says he ultimately chose INBONE because the design features a tibial stem that fits into the bone.
“The stem provides more vertical stability,” Fox says. “In the past, other products didn’t have that, so the joint loosened and caused problems.”
The patient, a 50-year-old male who suffers from rheumatoid arthritis, had already had ankle fusion surgery done on one ankle joint.
“He had the ankle fusion already and didn’t like it, so he wanted to know if I could do something different on the other side,” Fox says. “When I brought (ankle replacement surgery) up he was very enthusiastic about doing it.”
Recovery from the surgery involves six weeks of not putting weight on the joint, though patients can start doing non-weight-bearing physical rehabilitation two weeks following surgery.
Dr. Fox has already scheduled more surgeries, including one in mid February and a second one at the beginning of March.
While these surgeries have become more common and a far superior alternative to fusing the ankle bones together, Fox warns that patients need to have a realistic expectation of how active they can be once they heal.
“Joint replacement does not give a patient back their normal range of motion,” Fox warns. “You would need to stick to low impact activity. You can walk, but you can’t jog. You could use the elliptical, but you couldn’t do aerobics where you’d be bouncing up and down. Golf is OK but tennis would be out.”
Good candidates for total ankle replacement include those who have experienced joint trauma or who suffer from rheumatoid arthritis. The candidates should also have good circulation and maintain a healthy weight.
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