Health Technology

Advancements in Ankle Replacement are Getting People Back on Their Feet

Elaine Evans wanted to wear cute shoes again. But until a few years ago, she could barely walk.

A bone disorder called avascular necrosis, caused by steroids she received nearly 30 years ago, caused her joints to deteriorate. She’s had both shoulders replaced. Then the bones in her ankles began to go.

“It hurt to walk,” recalls the 69-year-old Williamsburg, Virginia, resident. “It hurt all the time.”

One doctor Evans saw wanted to fuse her ankles—a procedure that removes the worn-out part of the joint and permanently locks the bones together with screws and plates. Patients often do well with the surgery, and some 25,000 ankle fusions are performed in the United States each year.

Although ankle fusion is fairly successful at relieving pain, it causes loss in mobility and puts stress on other joints, such as the knee. Evans didn’t want that. Instead, she chose total ankle replacement surgery—also called ankle arthroplasty, which involves replacing the damaged joint with an artificial one.

Demand for surgery to replace ankles is on the rise as baby boomers—and their aging joints—reach their 60s and 70s. About 5,000 of the surgeries are performed each year in the U.S., a number the American College of Foot and Ankle Surgeons says has increased tremendously over the past few decades.

The hubs of ankle replacement surgery are generally considered to be in Baltimore, Maryland, and at Duke University Medical Center in Durham, North Carolina. But in Hampton Roads, ankle specialists at TPMG Orthopedics and Sports Medicine and Tidewater Orthopaedics have been performing the surgeries for several years.

Ankle replacement has been around since the 1970s, but it was virtually abandoned for a while because of problems with early devices. Newer technology and better implants that allow the ankle to move more freely have meant an increase in the procedures over the past decade.

“Some of the happiest people I have in my practice are my total ankle replacement patients,” says Dr. Matthew Hopson, who did Evans’ surgeries. “Most of these patients are now able to chase the grandkids around the backyard and participate in activities they weren’t able to before.”

Ankle replacement isn’t for young people, but for those in their 50s and up who suffer from rheumatoid arthritis, osteoarthritis, or the effects of a long-ago ankle injury that caused arthritis to develop in the ankle.

Although the ankle is the most stable joint in the body, any instability in the ankle over time can lead to arthritis. Loss or damage to the cartilage leads to the bones grinding against each other, causing pain, stiffness and swelling.

While ankle arthritis isn’t as common as hip or knee arthritis (about 800,000 total knee and hip replacements are performed per year), it’s just as debilitating. For Williamsburg resident Vivian Stull, every step had become painful. A cortisone shot gave her only temporary relief.

“If I walked, it hurt. If I sat down, it hurt,” says 57-year-old Stull, who had severe arthritis in both ankles because of a genetic condition. “There was no relief. Walking through the grocery store was a chore.”

Stull found herself no longer able to ride her bicycle or enjoy taking walks. She ended up getting both ankles replaced—the first in November 2011 and the second in January 2013.

Replacement won’t get someone running or climbing mountains, but it will allow daily activities without pain. Walking, golfing, swimming (no flippers) and non-impact exercise at the gym are all accepted activities. There have been anecdotes of people doing light jogging after ankle replacement, but most people who have the procedure weren’t runners before they had surgery. They just want to walk.

The surgery takes about two hours, but it’s an intricate procedure that requires skill and precise placement. After the surgeon shaves off the arthritic bone and cartilage, he inserts a three-component implant to create an artificial ankle. The materials are the same as those used in hip and knee replacements. The implants typically last about 10 years.

Unlike a hip replacement, where a patient is up and walking right away, the ankle is immobilized for six weeks—first with a cast, then a boot—in order to let the incision heal. After the six weeks, a patient can start walking. Best of all, they can live without pain.

“I can do the things I couldn’t do, in moderation,” Stull says. “I can walk the dog. I can walk through the grocery store without a cane.”