Total Ankle Replacement

Total Ankle Replacement

What is Ankle Arthritis?

Ankle arthritis is a debilitating condition.  Multiple studies have shown that ankle arthritis has a significant impact on quality of life that is just as significant as hip arthritis and chronic medical conditions such as diabetes. Ankle arthritis significantly decreases quality of life, social interaction, mobilization in society and has all of the negative impacts of chronic pain.

Frequently Asked Questions about Total Ankle Replacement

Unlike hip and knee arthritis which tends to affect an older to elderly population, ankle arthritis tends to occur in a younger patient population.  The hip and the knee tend to have cartilage that wears out with time producing arthritis in older patients; however the ankle has a different type of cartilage that is relatively resistant to old age degeneration but very susceptible to the effects of trauma.

The association of significant ankle trauma has been linked to the development of ankle arthritis for a very long time. It has been long known that ankle fractures frequently progress to post traumatic arthritis. It is very common to hear about someone that has broken their ankle and then consistently refer to it as their bad ankle. The more significant the energy and the type of ankle fracture the higher the likelihood of developing significant symptomatic ankle arthritis. Simple non displaced rotational fibular fractures have a low likelihood of going on to symptomatic arthritis while high energy pilon type fractures will progress to ankle arthritis almost 100% of the time. Over the past 20 years many studies have looked at the effect of minimal ankle trauma and have found that recurrent low energy trauma also can lead to the development of significant and symptomatic post traumatic arthritis at the ankle. Patients with recurrent ankle sprains in their teens, twenties and thirties have been shown to develop ankle arthritis in their 40s and 50s if the instability is not treated. Additionally, the inflammatory arthropathies like rheumatoid arthritis and lupus occur in the ankle frequently as well.  All of these conditions tend to occur in a younger patient population than hip and knee arthritis.

Historically, treatment for ankle arthritis has not been great; however, there has been significant progress and evolution with significantly more options and better outcomes. For early stage arthritis treatment consists of physical therapy, bracing, and medical management with anti inflammatories either oral or topical. Corticosteroid injection under ultrasound or fluoroscopic guidance can also be used to treat symptomatic arthritis and can produce 3 to 6 months worth of meaningful pain relief. Viscosupplementation has not been found to be particularly helpful in ankle arthritis and has been shown to cause a significant flare reaction, unlike in the hip, knee, and shoulder. Newer injection modalities have been found to be promising for use in ankle arthritis.  Amniotic allograft, platelet rich plasma, and stem cell therapy (either from iliac crest aspirate or from abdominal fat) have all had very encouraging results. These modalities all work thru a different mechanism of action but have been shown to decrease symptoms in arthritis, and constitue Regenerative Medicine treatment for Osteoarthritis of the ankle.

End stage ankle arthritis, that is arthritis which is unresponsive to all of the treatment modalities previously mentioned is generally treated with surgery. Historically, the only treatment available for ankle arthritis was an arthrodeisis which fused the ankle.  By eliminating the joint pain is eliminated, but motion is also eliminated as well. This leads to a limp, but more importantly, it causes joints adjacent to the ankle to increase the amount that they move to compensate for the motion lost at the level of the ankle. Multiple studies have shown that over time this leads these adjacent joints to become arthritic. On average these joints become significantly arthritis about ten years after an ankle fusion and this the progresses on to further significant surgery. Unfortunately, these joints also need to be fused or replaced and the ultimate result is a very stiff and not very functional leg, i.e. a peg leg.

Another technique, distraction arthroplasty of the ankle has been used to treat ankle arthritis. This technique involves placing and external fixator, like a scaffold, on the outside ankle and distracting the ankle to create more joint space. Although this technique initially had good results in the literature, mid to long term outcomes have not been as promising and there tends to be continued pain and disability at the level of the ankle post treatment.

Ankle arthroplasty, or total ankle replacement has been an emerging orthopaedic technology. Just like the ability to replace shoulders, hips and knees, we have the ability to replace the ankle with a prosthesis. First attempted in the 1960s, the first prosthesis available in the United States was approved by the FDA in 1997. This prosthesis underwent several design changes thru its lifespan and results progressively improved. Several more implants were approved in 2007 and have gone thru progressive improvements and updates. With each generation of implants results continue to improve in the short, mid and long term. Ankle replacement is a joint sparing procedure that allows for the removal of the arthritis in the joint and that joint is replaced by two metal components with a plastic polyethylene liner in between the two metal components. This is exactly the same as your hip and knee replacements. Each generation of total ankle and each new implant introduces exponential improvements in ease of use and improved outcomes, durability and longevity. The newest FDA approved and cleared total ankle is the Kinos Axiom total ankle. It introduces significant improvements over previous generation total ankles. This ankle replacement was designed to have a natural articulating geometry that is biomechanically accurate to a normal intact native ankle with continuous surface contact that will mimic and restore normal motion and function. The Kinos ankle provides motion in all three anatomic planes providing significantly more range of motion than all competitors in internal and external rotation as well as inversion and eversion at the level of the ankle. Most importantly the Kinos ankle significantly decreases stresses at the level of the articular surface. Studies have shown that there is and 80% reduction in contact stress and greater than 50% reduction in wear potential of the polyethylene liner because of this. This will ensuree that the Kinos Axion has a longer survivorship than its competitors do. The novel design of the Kinos has lead to significant improvements in implant to bone stability that is substantially better than all of the competitors.

Ankle Replacement in Central New Jersey and the Jersey Shore

Our board-certified foot and ankle surgeons at Seaview Orthopaedics offers a full range of nonsurgical and surgical treatments for ankle arthritis. Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury are happy to help with all of your treatment needs.

If you would like to schedule an appointment with Dr. Green for an Ankle replacement consultation, please call (732) 660-6200. We look forward to helping you!

The Fast Track To Recovery from Healthy Together

The Fast Track to RECOVERY

Joint Replacement patients can go home safely just hours after surgery.

Article from Monmouth Medical Center's "Healthy Together" Winter 2020 Publication.

Joint Replacement Surgeon
Meet Dr. Chalnick
Meet Dr. Parcells

Benefits of Outpatient Surgery

Studies show that outpatient joint replacement surgery is safe for the right patients, says David Chalnick, MD, Medical Director of the Joint Replacement Center at Monmouth Medical Center. In a study published in The Journal of Arthroplasty, researchers found that hospital readmissions and postsurgical complications were lower among outpatients compared to inpatients.

Best Candidates

To be eligible for the “Fast Track” program, a patient must be healthy and motivated to recover quickly, says David Chalnick, MD, Medical Director of the Joint Replacement Center at Monmouth Medical Center. Also, a patient needs a family member or friend who can accompany him or her to the hospital, attend physical therapy after surgery and help at home. Another requirement: “The home must be prepared for the patient to return to a safe environment amenable to recovery without injury,” says Dr. Chalnick.

It can be overwhelming to learn you need a knee replacement or a hip replacement. In addition to undergoing surgery, patients have traditionally been required to stay overnight at the hospital. Today, thanks to the new Fast Track Joint Replacement Surgery Program at Monmouth Medical Center (MMC), many patients are returning home to sleep in their own beds. “Fast track joint replacement is being pioneered around the country,” says Bert Parcells, MD, an orthopedic surgeon affiliated with MMC. “Patients who are healthy and recovering well don’t need to spend extra time in the hospital.”

Thanks to minimally invasive surgical techniques and “lighter” anesthesia, it’s safe to be discharged soon after surgery. Patients receive the same type of anesthesia as those who have traditional joint replacement, but “the anesthesiologists minimize the sedating effects, meaning they modify some of the medications,” says Mark Gesell, MD, an orthopedic surgeon affiliated with MMC.

Fast Track patients arrive at the hospital early in the morning, have the surgery, then head to physical therapy to ensure that they can be safely discharged. If all goes smoothly, they can go home in the afternoon. “Patients are very excited about this,” says David Chalnick, MD, Medical Director of the Joint Replacement Center at MMC and chair of the RWJBarnabas Health Total Joint Integrated Leadership Committee. “It’s a very pleasant experience.”

What to Expect

One month prior to surgery, patients can attend an in-person educational class and meet with a “graduate” of the joint replacement program. They also have the option of watching an educational video given by a nurse educator virtually. They discover a key benefit of having the procedure at a hospital: If it’s not safe for a patient to go home after surgery, he or she can stay overnight. “It’s an easy transition,” says Nicole Wilps, program coordinator at the Joint Replacement Center.

After a patient goes home, a nurse will check in with him or her the next day. Patients can choose to receive physical therapy at home or at an outpatient facility. The program, which launched in June 2020, has already seen a steady increase in patients.

Back to Walking

Joan Bennett of Oakhurst was experiencing arthritis-related pain in her right knee and had trouble walking. When the pain failed to improve after cortisone injections, she saw orthopedic surgeon Bert Parcells, MD, who recommended a partial knee replacement.

Joan arrived at Monmouth Medical Center at 5:30 a.m. on June 18, 2020. After the surgery, she spent a few hours recovering, then went to the physical therapy department. “The staff members gave me a walker and showed me how to go up and down stairs,” she says. Joan was then discharged with her husband. She required minimal pain medication and began outpatient physical therapy the next day. “I can bend my knee now,” says Joan, who is taking daily walks and can work in her yard. “The hospital staff was amazing.”

A Quick Recovery

Donna Farina of Wall Township was delighted she qualified for outpatient surgery for her right knee replacement in August 2020. A few hours after her surgery, which was performed by orthopedic surgeon David Chalnick, MD, she found herself in physical therapy, performing tasks such as getting out of a chair and climbing into a bed. “I was proud I was able to do everything,” she says. By late afternoon, she was back home.

After two weeks of at-home physical therapy, Donna went to a nearby facility, where she rode a stationary bike. After six weeks, she was making great strides and was back to walking without pain. “My physical therapist says I’m ahead of schedule,” she says. “I’m so glad I had the outpatient surgery.”

To learn more about the Fast Track Joint Replacement Surgery at Monmouth Medical Center, call 732.923.7971.