Thirty years ago, total ankle replacement surgery was not a successful option for patients. Almost all of the devices implanted ultimately failed.
Physicians primarily treated ankle arthritis and fractures with casting. This often resulted in more arthritis in the ankle. The aging population and the resulting baby boomer generation being healthier and more active has resulted in more cases of degenerative age-related arthritis.
The numbers of patients with osteoarthritis of the ankle will likely continue to grow as patients live longer and want to be active for longer periods. The design of the prosthesis began to improve in the late 1980s and within the past 10 years ankle replacement became a viable option for patients.
For some patients, one of the alternatives to total ankle replacement is ankle fusion. This involves implanting metal implants to hold the ankle bones together. The bone surfaces heal in this position and the joint is permanently stiff, although the result is usually a pain-free joint.
The main advantage of total ankle replacement is the return of some flexibility in the ankle. This movement is important for walking, exercising and climbing. Full movement of the ankle joint is never regained even with the surgery. However, much more movement is gained with a successful ankle replacement compared to an ankle fusion. Sometimes problems arise later when the joints begin to take the brunt of the force in the foot. That's when arthritis starts to develop.
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Ankle replacement
The main advantage of total ankle replacement is the return of some flexibility in the ankle.
 
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For people who've suffered through several failed ankle replacements or for those who have soft bones, a customized ankle replacement may be a good option.
Mark Myerson, M.D., an orthopedic surgeon at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, MD, has developed an implant that extends deep into the heel bone.
A typical prosthesis has a very small stem that can cause the ankle to collapse under the pressure of the foot. Dr. Myerson customizes the stem of his implant for each patient. If there is bone loss, damage or dead bone he builds up the prosthesis so that it sits all the way into the heel bone and is supported by the entire back of the foot, not just the ankle.
"It's a very clever device that allows patients to have an ankle replacement who otherwise would not be suitable candidates for this procedure," Dr. Myerson told Ivanhoe.
Dr. Myerson has been implanting his devices for about six years.
"Certainly in the short term the complication rate and the failure rate has been significantly less, so it's very exciting to see over the course of the next decade to see how these will outlive the more standard ankle replacement," he said.
