Ask Well: Ankle Replacements

Question: 
People can replace hips and knees, so why not ankles?

I understand that because of the number of bones and complexity of the other interacting parts, ankles aren’t easy to repair back to their original condition, but how about just a ball socket replacement?

Answer:
“We can and do” replace ankles, said Dr. Steven Weinfeld, an orthopedic surgeon and chief of the foot and ankle service at the Icahn School of Medicine at Mount Sinai in New York City. While not nearly as common as surgeries to replace a worn-out hip or knee, ankle replacement is on the rise, with as many 25,000 replacements likely to be performed this year in the United States, according to estimates from the American Academy of Orthopedic Surgery. Like hip and knee replacements, the procedure treats debilitating bone-on-bone arthritis.

Until recently, though, the preferred surgical treatment for severely arthritic ankles had been a procedure called ankle fusion, in which rods are inserted into the ankle bones, fusing them and preventing them from grinding together. Ankle fusion generally eliminates arthritis pain, Dr. Weinfeld said, but it also warps how someone moves and can increase stress on knees and other leg joints.

So, for many people, ankle replacement is a better option, he said, although it too affects gait, at least at first. “The way people walk often changes when they have arthritis” in their ankles, he pointed out. They begin to hobble, and after surgery, “have to learn to walk normally again, which can be surprisingly difficult sometimes.”

A more lingering concern is that today’s ankle replacement devices are projected to last only 20 years or so, he said, meaning that a 40-year-old might require multiple replacements of the device during his or her lifetime. For younger patients, Dr. Weinfeld urges physical therapy, bracing, painkillers or other nonsurgical options first. But if your ankles twinge and creak, he said, consult a sports medicine specialist or orthopedist about what would work best for your situation.

(Source: well.blogs.nytimes.com)