Ankle replacement no longer dismissed as quackery
Once disparaged as borderline quackery, the total ankle replacement is gaining acceptance as a treatment for crippling arthritis and serious injuries.
For years, doctors discouraged patients from getting the procedure — called ankle arthroplasty — because of persistent controversy over the earliest techniques, which involved cementing metal ankle reconstruction devices to bone.
Sometimes the parts loosened prematurely or caused infections, leaving patients in worse shape than before.
Rather than surgery, doctors prescribed anti-inflammatory drugs and pain relievers and recommended that patients wear comfortable shoes laced up to the ankles. In extreme situations, they sometimes recommended ankle fusion surgery, which uses screws, plates and bone grafts to fuse the bones on each end of the ankle joint into one continuous bone. However, that procedure left patients with little ankle flexibility and an unusual gait.
But now some orthopedic surgeons are performing total ankle replacements, in which bone and tissue are removed to make way for highly sophisticated metal and plastic implants. These doctors say that the procedure, which has taken decades to improve, is highly effective at relieving arthritic pain and enabling patients to regain the use of their ankle and resume a more active life.
This turnabout in medical treatment is due largely to the development of a half-dozen implant devices that were approved by the Food and Drug Administration beginning in the early 1990s.
These prosthetic devices — made of advanced metal alloy and plastic — cover both the major shin bone and the ankle bone and are engineered to interact with each other and the patient’s body in a way that maximizes mobility and flexibility.
At the same time, the medical profession has made great strides in developing better surgical techniques to ensure that the implants remain in place and function properly for years.
Improved surgical techniques and instruments allow doctors to put the artificial ankle in the correct position, said Selene Parekh, a foot and ankle orthopedic surgeon at Duke Health in North Carolina, which performs many of these procedures. “It is critical to make sure the ankle is balanced so that it has no unusual stress on it,” he said.