Published in UAB Insight, Fall 2007

New Protheses Offer Good Results

Advanced surgical techniques coupled with new ankle implant designs make total ankle arthroplasty an acceptable option for end-stage joint disease. UAB orthopaedic surgeon John S. Gould, MD, has refined the surgical technique to achieve favorable outcomes. His colleague John S. Kirchner, MD, also performs the procedure.

“Our goal is relieving pain, maintaining ankle motion and function, minimizing stress on surrounding structures, and preventing development of progressive arthritis in surrounding joints,” Gould says.

Ankle joint arthritis is most often seen in patients with severe posttraumatic arthritis, rheumatoid arthritis, or osteoarthritis. Symptoms and signs may include swelling, stiffness, increased pain with weight-bearing activity, decreased range of motion, visible ankle joint deformity, a limp, or instability secondary to pain.

According to Gould, other treatments for ankle arthritis include ankle supports and braces that limit or completely block motion or axially unload pressure on joint surfaces. Some devices both unload the joint and block motion.

Surgical treatments for extensive arthritis include ankle arthrodesis and total ankle arthroplasty. Clinical trials show that arthrodesis limits up-and-down motion of the foot and often results in arthritic changes in adjacent joints (Am J Orthop. 2004;33[4]:169-170). “Total ankle arthroplasty aims to maintain motion in the joint,” Gould says.

Prostheses
Unfavorable long-term results and high complication rates once limited use of ankle joint replacement. The new generation of prostheses has improved outcomes, however, and UAB surgeons commonly use the LP Agility Total Ankle Replacement, Salto Talaris Ankle, and In-Bone Ankle implants.

“The LP Agility dual anchor system addresses the cause of first generation implant failure, which was often due to loosening of the prosthesis resulting from poor bone fixation and improper alignment during installation,” Gould says.

The Salto Talaris Ankle anatomic design provides stability with a hollow fixation plug and three bone cuts to resurface the talus with minimal bone removal. “Bone preservation increases longevity and provides more options if revision surgery is required,” he says. “The Salto’s customized components offer precision alignment of the tibial and talar components, reducing stress on the joint, minimizing loosening and wear, and promoting reproducible results.

“New designs facilitate earlier mobilization and improved overall prosthetic longevity. Older Agility implants had an average 70% 10-year survivorship. New models should be more durable,” he says.

“Ideal arthroplasty candidates are aged 50 years or older, with postinjury or post-multiple-sprain arthritis or those who have experienced a prosthesis failure. Patients who have ankle fusions with adjacent arthritic surrounding joints also are candidates,” Gould says. “In the past, technical aspects of ankle replacement limited its usefulness, but current implants are carefully detailed, with precision equipment for insertion, which enables us to achieve excellent, reproducible results.”

For more information:
Dr. John Gould
1.800.UAB.MIST
mist@uabmc.edu