Issue link: https://viewer.e-digitaledition.com/i/441611
E ND -STAGE ANKLE ARTHRITIS is a debilitating condition that is frequently treated by experi- enced foot and ankle surgeons. Arthritis of the ankle negatively impacts an individual's quality of life as much as arthritis of the hip and congestive heart failure. It is estimated that by age 76, one of every five Americans will suffer from this ailment. Traditionally, the mainstay of treat- ment for end stage ankle arthritis has been arthrodesis (fusion) of the ankle joint. Ankle arthrodesis has a proven track record of being a n effective, reproducible, and predictable treatment strategy for end stage ankle arthritis. Despite excellent clinical results with ankle fusion, negative consequences of the procedure remain. It has been well documented that ipsilateral adjacent joint arthrosis is not only possible, but probable after a patient undergoes an ankle fusion procedure. These effects have most notably been seen at the subtalar joint and knee joints. Gait is also affected and has been clearly shown to be abnormal in those after ankle arthrodesis has been performed. Owing to the disappointing long-term sequelae associated with ankle arthrodesis, in addition to the continued success of hip and knee arthroplasty, the pursuit for a reliable ankle prosthesis is well documented in the medical literature. Naturally, implant designers turned t heir attent ion to t he a n k le joint after their success with hip and knee replacements. The first generation ankle implants were utilized during the 1970s with disappointing results. Revision rates were as high as 90 percent, and complications were high. These fail- ures were largely due to poor implant design, leading to increase in ankle joint constraints and loss of bone support. Ultimately, a vast majority of surgeons disregarded total ankle replacement as a surgical strategy to address end stage ankle arthritis. Over the last decade, noteworthy advances have been made in implant research, design, materials, surgical technique, and patient selection. The second and third generations of ankle prostheses have revolved around the concept of decreasing constraints at the joint interface. Recent prospective controlled trials and meta-analyses have suggested that modern implants offer comparable pain relief and perhaps better function than ankle arthrodesis. The question then becomes the realis- tic expectations and longevity of current prosthetic designs. Even with improved third and fourth generation implants, proper patient selection and implantation has been shown to be of vital importance for implant survivability. The size of the patient, as well as any limb deformity and patient lifestyles need to be taken into consideration. The reported five and ten year survival rates of modern day ankle implants have ranged from 80 percent to 98 percent, and 70 percent to 95 percent, respectively. The more favorable results have been shown to be typically performed by experienced ankle replacement surgeons. Treatment of end stage ankle arthritis is always a patient specific strategy. A full surgical consultation is performed and the options of fusion and replace- ment are discussed. Factors considered for each individual patient are weight, BMI, activity level, long term expecta- tions, level of deformity, and medical comorbidities. The options are weighed and ultimately the patient makes the choice. For patients we simply explain that both fusion and replacement offer near equal pain relieving properties. They both have a similar post-operative course, but with fusion one can expect a more long lasting result. Replacement does provide improved mobility, and decreases adjacent joint arthrosis, but there are no guarantees a second surgery won't be necessary in 10 to 15 years. Fusion or Replacement? SURGERY SPOTLIGHT By Aaron J. Chokan, DPM, FACFAS, and Duane J. Ehredt Jr., DPM, AACFAS Recent prospective controlled trials and meta-analyses have suggested that modern ankle implants offer comparable pain relief and perhaps better function than ankle arthrodesis. Treating End Stage Ankle Arthritis: 1 0 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ JA N UA RY/ F E B R UA RY 2 0 1 5