Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Ankle Replacement Surgery for Patients with Severe Ankle Arthritis

02.08.2004


Encouraging trends in the long term success of total ankle replacement were reported in a study presented at the American Orthopaedic Foot and Ankle Society’s (AOFAS) annual summer meeting today.



This study, conducted by Charles Saltzman MD, a Professor of Orthopaedic Surgery and Engineering from the University of Iowa, found total ankle replacement to be an option for patients with severe arthritis. Similar to hip and knee replacement surgeries, total ankle replacement involves removing the arthritic ankle joint and replacing it with an implant. Total ankle replacement was developed in the 1970’s but initially was plagued with high long term failure rates. The older prosthetics implants loosened or malfunctioned and frequently needed to be removed. Newer implants were developed in the late 1990’s that have made the surgery a more viable option.

In the study, Dr. Saltzman reported long term results with the use of the new Agility Total Ankle ( Depuy, Inc) implant developed by Dr. Frank Alvine. The Agility ankle consists of a bearing joint made of a highly mobile and refined polyethylene plastic and mimics the motion of a real ankle. The polyethylene meets with a polished metal surface acting as a hinge giving the patient a range of motion of 20 degrees. Dr. Alvine’s invention is currently the only FDA approved total ankle implant in use in the United States.


Prior to total ankle replacement surgery, the only surgical option for patients with disabling arthritis was fusion. This procedure involves fusing the bones together completely restricting ankle motion.

To measure the success of total ankle replacement surgery Dr. Saltzman initially studied the patients of Dr. Alvine four and a half years after they received their ankle implants. His new study re-examines those patients nine years after their surgery.

“The results of total ankle replacement are encouraging,” said Dr. Saltzman. “The new failure rate is 11% an improvement from previous reports in the past. This suggests that the newer designs are having good mid-term outcomes.” He warns that a failure rate of 11% still exceeds those of total knee and hip replacement. Although the procedure still needs improvement the implant is arguably better than joint fusion for selected patients according to Dr. Saltzman.

Future improvements will depend upon further training of doctors on how to use and properly implant the prosthetic device. The surgery should be done by surgeons with a background in total knee and total hip replacement who possess an extensive understanding of the foot and ankle.

Success also depends on the proper selection of patients. In Dr Saltzman’s study, the average age of the patients at the time of surgery studied by Dr. Saltzman was 63. To receive a total ankle replacement, a patient must have debilitating, end-stage arthritis.. End-stage arthritis can be intermittently extremely painful and leaves patients incapacitated. They find it difficult to stand and have a hard time maintaining employment. Furthermore, some ankle arthritic conditions are so severe that patients are unable to continue walking, even with the aid of a brace or cane. Most have been treated with anti-inflammatory medicine for many years without substantial relief. For these patients, surgery becomes the only option.

The short term complications associated with total ankle surgery are rare, but can be devastating. A deep infection can lead to removal of the implant and an extensive reconstructive surgery of the foot and ankle.

Long term problems include implants loosening and plastic irritation to the bone liner from deformation or wear. Sometimes the bone crumbles underneath the metal implant in a process known as subsidence. This type of situation will require revision surgery to strengthen the bone and reattach the implant. If the plastic liner frays, the small particles released can induce damage to the surrounding bone, accelerating the process of subsidence. This type of situation will require revision surgery to strengthen the bone and reattach or replace the implant.

Dr. Saltzman cautions that the implant is made of mechanical parts. “All mechanical parts wear out, so patients with long term use will sometimes require maintenance,” he said. Ideal candidates are elderly, inactive people with end stage arthritis simply because they are low demand and usually realistic about the capabilities of their implant.

“Patients need to be realistic about the limitations and expectations with use of an ankle replacement,” Dr. Saltzman says, “but it is a viable option to treat people with debilitating end-stage ankle arthritis.”

The AOFAS is the leading professional organization for orthopaedic surgeons specializing in disorders of the foot and ankle. Orthopaedic surgeons are medical doctors with extensive training in the diagnosis and treatment of the musculoskeletal system that includes bones, joints, ligaments, tendons, muscles, and nerves.

| newswise
Further information:
http://www.aofas.org

More articles from Health and Medicine:

nachricht Building blocks for new medications: the University of Graz is seeking a technology partner
19.03.2019 | Karl-Franzens-Universität Graz

nachricht Scientists find new approach that shows promise for treating cystic fibrosis
14.03.2019 | NIH/National Heart, Lung and Blood Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Stellar cartography

The Potsdam Echelle Polarimetric and Spectroscopic Instrument (PEPSI) at the Large Binocular Telescope (LBT) in Arizona released its first image of the surface magnetic field of another star. In a paper in the European journal Astronomy & Astrophysics, the PEPSI team presents a Zeeman- Doppler-Image of the surface of the magnetically active star II Pegasi.

A special technique allows astronomers to resolve the surfaces of faraway stars. Those are otherwise only seen as point sources, even in the largest telescopes...

Im Focus: Heading towards a tsunami of light

Researchers at Chalmers University of Technology and the University of Gothenburg, Sweden, have proposed a way to create a completely new source of radiation. Ultra-intense light pulses consist of the motion of a single wave and can be described as a tsunami of light. The strong wave can be used to study interactions between matter and light in a unique way. Their research is now published in the scientific journal Physical Review Letters.

"This source of radiation lets us look at reality through a new angle - it is like twisting a mirror and discovering something completely different," says...

Im Focus: Revealing the secret of the vacuum for the first time

New research group at the University of Jena combines theory and experiment to demonstrate for the first time certain physical processes in a quantum vacuum

For most people, a vacuum is an empty space. Quantum physics, on the other hand, assumes that even in this lowest-energy state, particles and antiparticles...

Im Focus: Sussex scientists one step closer to a clock that could replace GPS and Galileo

Physicists in the EPic Lab at University of Sussex make crucial development in global race to develop a portable atomic clock

Scientists in the Emergent Photonics Lab (EPic Lab) at the University of Sussex have made a breakthrough to a crucial element of an atomic clock - devices...

Im Focus: Sensing shakes

A new way to sense earthquakes could help improve early warning systems

Every year earthquakes worldwide claim hundreds or even thousands of lives. Forewarning allows people to head for safety and a matter of seconds could spell...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

International Modelica Conference with 330 visitors from 21 countries at OTH Regensburg

11.03.2019 | Event News

Selection Completed: 580 Young Scientists from 88 Countries at the Lindau Nobel Laureate Meeting

01.03.2019 | Event News

LightMAT 2019 – 3rd International Conference on Light Materials – Science and Technology

28.02.2019 | Event News

 
Latest News

Levitating objects with light

19.03.2019 | Physics and Astronomy

New technique for in-cell distance determination

19.03.2019 | Life Sciences

Stellar cartography

19.03.2019 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>