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Total
ankle replacement appears to be an option for patients with
severe arthritis, according to a study reported July 29 at
the American Orthopaedic Foot and Ankle Society's annual meeting
in Seattle.
Similar
to hip and knee replacement surgeries, total ankle replacement
involves removing the arthritic ankle joint and replacing
it with an implant. Developed in the 1970's, total ankle replacement
was initially plagued by high failure rates as older prosthetics
implants loosened or malfunctioned and frequently needed to
be removed.
An improved
implant called the Agility Total Ankle implant has made the
surgery a more viable option, according to the study.
Researcher
Charles Saltzman MD, a University of Iowa professor of orthopaedic
surgery and engineering, evaluated the success rate of the
Agility Total Ankle implant, which is the only FDA approved
total ankle implant in use in the United States.
The Agility
Total Ankle implant consists of a bearing joint made of polyethylene
plastic that mimics the motion of a real ankle, giving the
patient a range of motion of 20 degrees.
Saltzman
studied patients nine years after they had undergone surgery
to receive their ankle implants. He found the failure rate
to be 11 percent, an improvement over the results of past
evaluations. In the study, the average age of the patients
at the time of surgery was 63. To be eligible to receive a
total ankle replacement, a patient must have debilitating,
end-stage arthritis.
"This
suggests that the newer designs are having good mid-term outcomes,"
he said, although it still exceeds the failure rate of total
knee and hip replacement. Although further improvements are
necessary, he said the Agility Total Ankle implant is arguably
better than joint fusion for selected patients.
Besides
the proper selection of patients, Saltzman said future improvement
depends upon training doctors on how to use and properly implant
the prosthetic device. Only surgeons with a background in
total knee and total hip replacement who also have an extensive
understanding of the foot and ankle should perform ankle replacement
surgery, he added.
"Patients
need to be realistic about the limitations and expectations
with use of an ankle replacement," said Saltzman. "But
it is a viable option to treat people with debilitating end-stage
ankle arthritis."
Source:
Medical Week Staff, week
of July 26, 2004
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