Treating Ankle Arthritis: Total Replacement?


BALTIMORE, Md. (Ivanhoe Newswire) — A stumble on the sidewalk, a turn in high heels, or a fall on the sports field, ankle sprains happen to just about everyone. Most heal successfully on their own, but about five or ten percent of the time severe sprains, or even a bone break, can cause arthritis. For a growing number of patients, total ankle replacement surgery has been the solution.

81-year-old Hazel “Joyce” McNeil works out almost every day.

“I like it cause it’s whole body.” McNeil explained to Ivanhoe.

Years ago McNeil would not have been able to workout because of severe pain in her ankle. It started with a wintery day half a century ago.

McNeil said, “I fell on a piece of ice that was probably the size of a dime.”

Her leg broke in seven places. Doctors reset the bone, but it was never quite the same.

“Because of all those years, 40-50 years of her walking on a little bit mal-aligned leg, over time the ankle joint was worn down.” Clifford Jeng, MD, an Orthopedic Surgeon at Mercy Medical Center in Baltimore, Maryland explained.

McNeil lived with arthritis until she was in her sixties.

“I felt so miserable and I limped so much that it tired me out. I was ready.” McNeil stated.

Dr. Clifford Jeng says instead of fusing the bones, more patients are turning to total ankle replacement to relieve chronic pain.

“We can keep the motion with an ankle replacement, they have a more normal gait and the pain relief has been shown to be equivalent to an ankle fusion.” Dr. Jeng said.

Dr. Jeng says a new generation of replacements means surgeons remove a lot less bone. The replacements are successful in eighty percent of the patients over ten years. McNeil is going on fifteen years, keeping her on her feet and independent.

“I don’t want to be a burden to anybody.” McNeil said.

The gold standard for treating chronic ankle pain has been fusion, but Dr. Jeng says many patients don’t like the stiffness that comes with that surgery. He also says total ankle replacement is not the best option for everyone. Those with diabetes or other underlying health conditions would not be good candidates for the surgery.

Contributors to this news report include: Cyndy McGrath, Field Producer; Roque Correa, Editor.

REPORT #2385

BACKGROUND: Ankle injuries are the most common orthopedic injuries and the most frequently seen in the emergency room, normally due to sports. There are around 1,000,000 to 10,000,000 cases per year in the U.S. and there is no significant difference in the amount of injuries between male and female patients. Around 90-95% of ankle sprains are benign and will heal on their own by following the RICE (Rest-Ice-Compression-Elevation) steps. Nevertheless, 5-10% of cases linger and patients don’t recover on their own. If not treated properly, these ankle sprains can cause ankle arthritis. Any fracture that breaks into the joint can cause arthritis, especially if it does not heal perfectly aligned.

(Sources: Elsevier BV & Dr. Clifford Jeng)

ANKLE ARTHRITIS SURGERIES: If the ankle fracture or arthritis is causing pain and interfering with its function, medication and surgery may be necessary. The most common type of surgery is an ankle fusion where surfaces of the joints that are affected are removed and joining the bones with plates and screws, allowing them to fuse together. This procedure immediately reduces pain, but it leaves the patient with little mobility of the ankle. For this reason, more patients are looking into total ankle replacements, where an incision is made in the front of the ankle, the damaged bone and joint cartilage are removed, and the artificial joints are attached. This procedure reduces pain and allows for more motion and flexibility. The decision of getting a total ankle replacement requires a consultation with an orthopedic surgeon who is experienced in both ankle fusion and ankle replacement. Furthermore, Dr. Jeng says people with diabetes, diseased or damaged bone around the ankle, severe deformities, poor soft tissues, or previous infections should avoid altogether an ankle replacement.


QUESTIONS TO ASK BEFORE SURGERY: Your doctor will ask you questions and consider many things prior to any orthopedic treatment or surgery: age, activity level, and general health. You should also be prepared and ask your own questions, such as:

  1. Why is this procedure being recommended? Are there alternatives?
  2. What are the benefits of this procedure in terms of pain relief, functioning/mobility? How long will the benefit last?
  3. What are the risks involved?
  4. What is the success rate for this procedure?
  5. What is the procedure called? How is it done?
  6. Will this surgery solve the problem? Will any more surgery be required in the future?
  7. How many of these procedures are annually performed at this hospital?
  8. What percentage of patients improve following the procedure?
  9. What will happen if I don’t have the surgery now?
  10. If I want a second opinion, whom can I consult?
  11. Will I need any tests or medical evaluations prior to the surgery?
  12. What kind of anesthesia will be used? Are there possible after effects or risks? Will I meet with the anesthesiologist in advance? Will her or she know my needs/allergies?
  13. What kind of implant or prosthesis will be used? What are the outcomes using this device? How long will it last?
  14. Will I have pain following the procedure? What pain relief or pain control measures will I be given?
  15. How long will the recovery take? What are my limitations during recovery? Will I need assistance at home afterwards? For how long? What will discharge instructions be?
  16. Will I have any disability following surgery? Will I need physical therapy?
  17. When can I return to work? When can I drive my car? When can I have sexual activity?
  18. Are there any materials about this surgery that I can review?


* For More Information, Contact:

Clifford Jeng, MD

Orthopedic Surgeon

Mercy Medical Center, Baltimore

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