A New and Better Ankle
Total ankle replacements (TAR) have been available to patients in the United States since the early 1970’s. Naturally, these implants have undergone various design evolution phases. A review article published in the September 2008 issue of the Journal of the American Academy of Orthopedic Surgeons (http://www.jaaos.org/) discusses the different types of total ankle replacement implants currently available.
“When we started off, the ankles we used in this country included just two components and we had to use bone cement to fix them and basically they all failed,” said Andrea Cracchiolo, MD, lead author of the article and Director of the Adult Foot and Ankle section at UCLA Medical Center. “The difference between the first generation implants and those today is that you don’t need to use bone cement. The surfaces are such that the bone will grow into the joint much like in total hip replacement.”
As of present, there are four designs that are approved by the Food and Drug Administration for use in the United States. All four designs consist of the two-component designs which are considered fixed implants. Yet, for numerous years now, many surgeons outside of the United States have been using a new three-component ankle design. According to Dr. Cracchiolo, a three-component ankle could possibly allow for additional movement, mobility, and flexibility in the joint. Additionally, it may also be easier for orthopaedic surgeons to implant. Although here in the U.S. a three-component device has been recommended for approval by the Food and Drug Administration, it could take until late 2008 (or longer) before it would be made accessible to U.S. patients.
Although total ankle replacement offers many patients more mobility compared to the option of fusion to repair the injured joint, not every patient is an ideal candidate. As Dr. Cracchiolo explains, patients need a detailed evaluation from a qualified orthopaedic surgeon who feels the procedure may be suitable. “Some patients have such deformity of the ankle or have an ankle that is so unstable that total ankle replacement is not indicated,” explains Cracchiolo.
According to the American Association of Orthopaedic Surgeons there are signs that you may be a candidate for a total ankle replacement. These signs include:
• Having a destroyed ankle, meaning the surfaces of the ankle are gone
• Having advanced arthritis of the ankle
• The condition of your ankle is interfering with daily activities and causing pain
Total ankle replacements can offer patients:
• Better motion of the ankle compared to fusion
• Protection in the small joints below and in front of the ankle from developing arthritis
• Relief of ankle pain
There are approximately 20 total ankle replacement implants worldwide that are currently available or in their final stages of design. Nonetheless, there have only been a limited number of clinical studies involving such implants. Dr. Cracchiolo says, “Great care must go in to selecting not only the ideal patient, but also the implant that should be used. We need more long-term follow up clinical studies on implants here in the U.S. In addition, if patients are young, they should understand that the ankle replacement, just like the hip and knee, is not going to last a life time.”
“As improvements in design continue to evolve, the goal is to develop total ankle replacements that are comparable to hips and knees in terms of quality and longevity,” noted Dr. Cracchiolo.
SOURCE: American Academy of Orthopaedic Surgeons
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