Total Ankle Replacement Gaining Foothold in Rochester

March 12, 2008

A procedure aimed at not only relieving pain from arthritic ankles, but providing new-found mobility for patients, is gaining a foothold in upstate New York. University of Rochester Medical Center orthopaedic foot and ankle surgeons are the only in upstate New York currently offering this surgery, an alternative to the current gold standard treatment, ankle fusion surgery.

While often overshadowed by our body’s larger joints like the hip or knee, the ankle in fact carries a larger weight and force due to its smaller size, absorbing four times the body weight with each step -- more than double the weight taken on by the hip and knee, according to Judith Baumhauer, M.D., professor and member of the Division of Foot and Ankle Surgery in the Medical Center’s Department of Orthopaedics.

"The ankle not only has to provide stability for our body as we walk, run, jog, twist and turn, but it must do so while bearing enormous weights,” Baumhauer said. “This weight-bearing role means that when an ankle is ridden with arthritis, the pain can be particularly severe and debilitating leading to less activity and function. It also is common for people to have back, hip or knee pain due to their painful limp.”

Patients with ankle arthritis typically undergo a regimen of conservative treatments such as anti-inflammatory medications, ankle braces, and corticosteroid injections. If these treatments are unable to bring the pain under control, patients can opt for an ankle fusion, a surgical procedure where the ankle joint cartilage is removed, and screws are inserted across the joint to allow the bones to grow together. As a result of the surgery, a patient’s ankle is permanently fused into a 90-degree angle with the leg to allow walking.

“While this surgery successfully relieves patients’ pain and suffering, the loss of motion that results from the permanent fixed position of the ankle places additional stress on surrounding joints, often causing other problems,” Baumhauer said. “Ankle joint replacement surgery allows us to offer the best of both worlds to our patients: pain relief, and range of motion preservation that increases patients’ mobility without placing additional burdens on other body joints.”

The medical community has experimented with total ankle replacements on and off since the 1970s, but it’s only been in the past decade that physicians have begun producing positive outcomes using newer equipment that can withstand the wear and tear that comes with everyday standing and walking. During an ankle replacement surgery, the entire ankle joint is removed, and replaced with metal and plastic parts much like a hip or knee replacement.

Not all patients are candidates for total ankle replacement surgery. Like other joint replacement surgeries, younger patients (under 55) are rarely eligible due to equipment wear-out factors, and obese patients, who would place a heavy burden on the mechanical device, also are not the best choice for an ankle replacement.

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