Ankle replacements give patients more viability
By Brett Dworski
It’s been over 40 years since Dan Chesman, a former ROTC Naval Officer at Miami University in Ohio, shattered his ankle in a toboggan accident.
At the time of the accident, back in 1972, the latest surgical treatment was to fuse the ankle bones together, which would have caused very limited mobility. Chesman instead decided to wait, although his doctors constantly recommended a fusion procedure.
“A series of pins were put in to help stabilize the ankle, and it was able to heal somewhat with physical therapy at first, but the pain still became unbearable,” Chesman says. “As time went on, especially in the last few years, the pain increased to the point where I couldn’t even tie my shoes or walk to the train station. I knew it was getting to the point where something needed to happen.”
Chesman then heard about orthopedic staffs bringing in foot and ankle specialists to conduct total ankle replacements. He eventually met with Anand Vora, MD, from Illinois Bone and Joint Institute (IBJI), and from that point on, Chesman says, it was a no-brainer that he should go through with the replacement.
Fast forward to after the procedure: Dan Chesman feels like a new man, literally.
“Even before I left the hospital, I was able to stand up, and I saw at that moment it was the right thing to do,” he says. “It was like, ‘Wow, I can do things I haven’t been able to do in a long time’ such as taking long walks in downtown Chicago.”
So how do ankle replacements actually work?
According to Vora, ankle replacements are options for someone with end stage or advanced ankle arthritis.
“Just like with any other joint, what happens with ankle arthritis is [that] the two ends of the bone become arthritic, and the cartilage wears away,” Vora says. “As that happens, the two ends of the bone rub together, which results in pain, almost like two pieces of sandpaper rubbing without a cushion in between.”
Steven Haddad, MD, at IBJI Glenview, says there are three types of ankle arthritis that would require an ankle replacement:
• Primary osteoarthritis, commonly referred to as old-age arthritis
• Posttraumatic arthritis, which results from an old injury or ankle fracture
• Systemic arthritis, which results from diseases such as rheumatoid arthritis
In Chesman’s case, it appeared to Vora that he had posttraumatic arthritis.
According to Simon Lee, MD, at Midwest Orthopaedics at Rush, ankle arthritis is 70–75 percent less common than knee and hip arthritis, which are both more wear-and-tear based and often occur with aging. Ankle arthritis more commonly occurs after an injury.
The actual replacement procedure may vary, depending on the bone and tissue around the ankle joint, according to Haddad. “Any [misalignment] of the foot due to long-term deformity must be corrected so the ankle joint is perfectly balanced above the foot,” says Haddad. “If the patient has ankle instability along with the arthritis, ligament reconstruction is then done at the same time as the replacement.”
Once these factors are addressed, the bulk of the procedure is done. The ankle replacement itself involves the complete resurfacing of the ankle joint, where a metal lining is then placed on the end of each bone, and a plastic spacer is inserted in between, providing stability and mobility.
Ankle replacements are an improved alternative to the former method of treatment, ankle fusions, which was Chesman’s first option four decades ago. Unlike ankle replacements, which provide mobility from the spacer and metal linings, ankle fusions take away that mobility due to the bones being secured together with plates and screws.
“A common problem with ankle fusion is the development of arthritis in the joints adjacent to the fused ankle joint due to increased stress from being forced to move in directions they are not built for,” says Haddad. “Patients with fused ankles walk slower and with a shorter stride as they vault over the stiffened ankle joint.
“It’s important to discuss with your doctor the benefits and risks of any procedure before going through with it,” Haddad adds. “That is the best way to avoid disappointment with the outcome of the surgery.”
According to Vora, some benefits with ankle replacements include pain relief, maintaining and improving mobility and maintaining a higher level of function. However, he also says a risk with ankle replacements is that they can wear out over time, causing the need for another procedure. Like any procedure, other risks include infection, nerve damage, incisional wounds and blood clots.
“Although ankle replacements are making great strides, foot and ankle specialists are still in the learning curve. Currently, only a few studies prove how patients function years down the line after their procedure,” says Lee.
So far, Chesman is obviously enjoying the benefits that his procedure has given him.
“I got a new life from it,” he says. “I wish my wife liked to dance because I want to take dance lessons now. For anyone considering it, do it—just do it.”
Highlights of Full Ankle Replacement Surgical Technology
Diseased portion of the ankle joint (tibia) bone being removed to make room for the ankle implant
Lower half of the ankle bone being removed (talus)
Guide (on the ankle) for making the remainder of the bone cuts to prepare the new ankle joint for implantation of the components
Metal components inserted into the tibia bone to eventually be attached to the plate that holds the polyethelene (cushion) for the implant
New implants fully inserted and fixed to replace the tibia and talus
Originally published in the Fall 2015 print edition.