Synopsis: Hip and knee replacements are common, and doctors now say ankle replacements have become technically good enough to make fusion obsolete for arthritis patients in pain. A doctor & patient discuss.
Host: Nancy Benson. Guests: Dr. Simon Lee, foot & ankle surgery specialists, Rush University Medical Center & Midwest Orthopedics, Chicago; Robert Corwin, ankle replacement patient and judo instructor, Yorkville, IL.
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Nancy Benson: Total knee and hip replacements are quite common these days. According to the Agency for Healthcare Research and Quality, doctors perform nearly 300,000 total hip replacements and 600,000 knee replacements each year. What you may not realize is that orthopedic surgeons can now successfully replace ankles, too.
Lee: Most of us probably know or have neighbors or relatives who’ve had a knee or hip replacement. Typically those joints essentially wear out over time from wear and tear or the aging process in the joint. The unusual thing about the ankle is, actually the vast majority of ankle arthritis is caused by trauma — previous injuries or ankle fractures, for example. Sometimes the patients that require a ankle replacement tend to be a little bit younger and to some degree generally were more active and more functional.
Benson: That’s Dr. Simon Lee, a specialist in foot and ankle surgery at Rush University Medical Center and Midwest Orthopedics in Chicago.
Lee: We would say we are between our second and third generation of ankle replacements. This is not a new idea in foot and ankle. It was actually used and created even back into the 60s and 70s. What we found back then was that a lot of the joint replacements, a lot of the ideas and theories and the implants that we used failed, and failed miserably. So to some degree we scrapped that whole idea for a while and within the last 10-15 years have ankle replacement smade a comeback. The reason I think they are so successful nowadays is we’re building upon the information, the knowledge, the technology that hips and knees have and using that to supplement what we’re doing in the ankle now.
Benson: Lee says that many people who need an ankle replacement are in severe pain due to arthritis, often the result of an injury. Thirty or 40 years ago, surgeons could provide pain relief, but with a major downside.
Lee: Some people would consider the gold standard of ankle arthritis treatment or surgery was unfortunately fusion. Fusing the joint closed or welding that actual joint. The problem with that is most of us can go back and think about any joint that we have in the body that moves and has a normal movement as part of its function and imagine that if we froze it or fused it, just doesn’t make a lot of sense. Ultimately for the ankle, we know that fusing the angle causes a lot of subsequent undue stress and stresses on other areas of the body. For example the other leg, the knee, the hip, the low back. So, as a result arthritis accelerates or builds up in other areas as a result of an ankle fusion.
Benson: Fortunately, today’s ankle replacement provides both pain relief and ankle flexibility.
Lee: There are three bones that are surrounding the “ankle joint.” There’s the bone in the foot that we call the talus, and then the two leg bones, essentially I think some people characterize it as the shin. Those are two bones that help trap that talus bone in-between them. We actually come through the front of the ankle and cut out part of the actual ankle joint and replace that with metal on either side of the joint. That helps support the prosthetic. Typically there’s a high-tech plastic that resists pressure and also friction that almost acts as a joint, so that allows the motion to be maintained
Corwin: I’m the head of the Yorkshire judo club and I have some other instructors that work underneath me. So I was down there more in a supervisory capacity because it really hurt to walk on my ankle. And then I had a clicking noise where it would be impossible to sneak up on somebody because they could hear me coming. It got to the point where it was so painful to walk on it I decided I had to do something about it.
Benson: That’s 81-year old Robert Corwin, who is once again an active judo instructor in Yorkville, Illinois. But before his ankle replacement he was on the sideline.
Corwin: To be able to move the ankle normally is very important in judo because of the nature of the sport. A lot of times all your body weight, plus your opponent’s weight is on one leg, on one ankle. You have to be able to lean forward on the ball of your foot and to throw in forward throwing techniques. Ankle replacement was the best option because I’d had multiple hip replacements, I’d had knee replacement. They all worked out great.
Benson: Lee says patients begin to move the ankle around during physical therapy in the first six to eight weeks, but can’t bear weight on that ankle yet.
Lee: Most patients are in this graduated return back to weight bearing and functional activity for the next six to eight weeks. Most patients are about three or four months out from the actual ankle replacement before they are trying to put regular shoes on, or getting back into the normal routine and activity. Most patients are probably nine months to a year before they can say that they are back to everything that they want to do. That being said, while the ankle replacement is good, it’s not great. Most of us would probably recommend and council our patients to avoid any repetitive or high impact type activities. So running or jogging is not something we would recommend after an ankle replacement. Certainly other activities like riding a bike, golfing, walking for exercise, some judicious elliptical use, for example, is okay, swimming is okay.
Benson: And apparently, judo is okay, too.
Corwin: Because of my age I just teach technique and demonstrate it, but I also teach sports performance classes where we’re doing a lot of running technique, quick foot ladder, jumping and all that. I can demonstrate that where before I had the ankle replacement it was to the point where I couldn’t demonstrate anything.
Benson: Experts say total knee and hip replacements can last up to a good twenty years or more. Ankle replacements don’t have quite as good a track record, at least not yet.
Lee: When I started this practice in foot and ankle I couldn’t actually tell patients how they would do in ten years because we didn’t have that data and we didn’t know. Ultimately, ankles, we’re not quite there in terms of knees and hips. Most of us would hope that most of these implants would last 12 to 15 years for the majority of the implants. We’re looking at 85% of these implants lasting 12-15 years at least. Ideally, as we continue to study these implants and follow the trends we can figure out why some of these will fail earlier and then incorporate that into future upgrades or technology of the ankle replacements to extend that even more.
Benson: For the time being, you may still need to travel to find a medical center that specializes in ankle replacement. But Lee says you can be assured that a painful ankle joint can be replaced these days with good results. You can learn more about ankle replacement through our web site at radiohealthjournal.net. Our writer this week is Polly Hansen. Our production director is Sean Waldron. I’m Nancy Benson.