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End stage of arthritis in the distal lower extremity has almost always dictated fusion of a joint. Until relatively recently this was the case in the ankle. However, due to its essential role in normal gait, surgeons have long sought ways to replace rather than fuse this joint.
Replacement joints have existed for decades. Early versions were fraught with complications and required revision and conversion to fusion very often. Like many procedures, refinement in design of the implant, instrumentation, and patient selection has resulted in newer versions that have fairly decent and predictable durability.
The ideal patient has lower functional demands, although physically active. Adequate bone stock, a lower BMI, and adherence to strict post operative protocols round out the characteristics for a patient who will likely benefit. Morbid obesity, uncontrolled systemic comorbidities, peripheral vascular disease, neuropathy, and patients who cannot follow through with strict rehab protocols will likely have less than optimal outcomes, often requiring revision or conversion early on in their recovery.
The decision to replace rather than fuse is highly individualized. Regardless of patient health, they must understand that the likelihood of some further intervention is high. This is due to the wear characteristics of the polyethylene component and high load going through the relatively small ankle joint surface area. Despite this, maintenance of sagittal plane motion becomes a deciding factor along with age, adjacent joint health, and overall desire for a more normal gait (not entirely 'normal') for a longer period of time.
The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
