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Total Ankle Replacement

For many arthritis sufferers, the benefits of replacing this pivotal joint outweigh the costs of trying to save it.

These days, it’s not uncommon to hear of someone who has had a hip replacement or a knee replacement for one reason or another. That said, even within the medical community, the fact that the human ankle joint can be successfully replaced still turns heads. “Wow, that’s fantastic!” says a physician who recently recovered from knee surgery. “The ankle has more weight placed upon it than any other joint and its range of movement is greater than any other joint as well.”

For patients, it’s the freedom of movement that the total ankle replacement provides which is truly amazing. Wrote one grateful husband of a total ankle replacement patient, “Thank you for giving us our life back.” Another patient has recovered her life as a dog trainer. Others are able to enjoy walking, golfing, and even doubles tennis.  With ankle fusion surgery, or no treatment at all, these types of activities are not typically feasible.

As shock absorbers to the human body, feet cushion up to one million pounds of pressure during one hour of strenuous exercise. Walking puts up to 1.5 times your body weight on your feet (which log approximately 1,000 miles per year).

Dr. Neufeld, Dr. Buchanan, and Dr. Cuttica have one of the nation’s leading practices in total ankle replacements in the United States. (Please see “Medical Staff” for specifics.) There is a lot of stress across a very small joint and is a challenge for engineers to perfect what the natural joint can do. Today’s total ankle replacement technology comes extremely close; because of these challenges, ankle replacements have required decades more research than knee and hip replacements even though they all came into existence in the 1970s.


Gaining Traction

During the past decade, total ankle replacements (TAR) have quietly been gaining traction as materials and engineering have evolved, the ankle replacements are only in their fourth or fifth generation of development. The surgeons at The Orthopaedic Foot & Ankle Center perform hundreds of total ankle replacements a year.

Unlike most orthopedic surgeons who are certified to work with a single brand of FDA-approved artificial ankle replacements, both Dr. Neufeld and Dr. Buchanan are licensed to implant four different brands of artificial ankles. As a result, they are able to find the optimal solution for patients who are ready to take the next step in curing debilitating and painful conditions of foot and ankle arthritis. (See “Anatomy of Arthritis” below.)

During the 1980s, ankle replacements fell out of favor because the cement that was used to adhere the implants to bones was not reliable and the stress placed upon the artificial parts was too great for them to bear. Cement is no longer being used and the newer materials provide a sufficient product lifecycle. The newest generation of products has been in use for two to three years and the results have proved successful.

In times past, due to the unreliability of artificial ankles, surgeons opted to simply weld the foot directly to the leg using arthrodesis, severely limiting the range of motion but relieving the pain associated with ankle arthritis. (See “Foot and Ankle Arthritis Medical Procedures”) In fusion surgery, the ankle joint and the shinbone grows onto the talus, the first large bone of the foot. Ankle fusion results in loss of up-and-down movement of the foot. A new artificial ankle, however, preserves natural joint movement and offers important benefits that Dr. Neufeld can discuss in detail with you. These benefits include:

  • greater ankle support and longer-term stability than earlier implants;
  • multiple sizes and types of artificial ankles so that your precise needs may be addressed; and,
  • more natural joint movement than is possible with ankle fusion surgery.


The Anatomy of Arthritis

There are 28 bones and over 30 joints in the foot. Tough bands of tissue, called ligaments, hold the bones and joints in place. If arthritis develops in one or more of these joints, your balance and walk may be affected. The foot joints most commonly affected by arthritis include:

  1. Tibiotalar joint, ankle joint,where the shinbone (tibia) rests on the uppermost bone of the foot (the talus.
  2. Hind foot joints:a) Subtalar or talocalcaneal joint, where the bottom of the talus connects to the heel bone (calcaneus)b) Talonavicular joint, where the talus connects to the inner midfoot bone (naviculus; and thec) Calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid)
  3. Midfoot joint, or metatarsocunieform joint, where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cuneiforms)


Walk Away From Pain

According to past patients of The Orthopaedic Foot and Ankle Center, being free from chronic pain far outweighs the short-term pain of surgery. (See, “Testimonials.”) To ensure that his patients suffer the least amount of pain and recovery the greatest amount of motion in the least amount ot time, The physicians at the Center have researched pain management extensively and published research papers on the topic.

The Center’s sophisticated pain management program is custom-tailored to ensure the quickest possible recovery for their patients—with as little pain as possible.  The Orthopaedic Foot and Ankle Center tries to use removable braces instead of casts so that the muscle doesn’t atrophy. Half of the solution to the physical pain and suffering is post-op recovery. The team at here at The Orthopaedic Foot & Ankle Center has developed a regimen to get patients moving and back into activities exhibiting successful recovery.

When the Total Ankle Replacement surgery is  taken in concert with post-op therapy and pain management, successful results happen.  In the vast majority of cases, surgery brings pain relief and makes it easier for patients to get back to their daily activities.

A major benefit of total ankle replacement is that other joints are protected from the risk of arthritis because stress will be distributed evenly and equally and you’ll have a greater range of motion.

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