The ankle is an important joint in the body that is often overlooked and lacking in proper care. If proper care and treatment are not received, especially in cases of ankle degeneration, osteoarthritis or ankle injury, the result may be ankle deformity and a reduction of the range of motion in the ankle, which could eventually lead to more serious disabilities. The pain, swelling, and difficulty on walking that come with ankle conditions or injuries can reduce physical capabilities, cause anxiety, and increase mental stress levels to the point that it affects the patient’s activities on daily living and overall quality of life.
Effective treatment of ankle injuries is more complex than treatment for other joints in the body. This is because the ankle has less blood flowing to it than other areas— artery carrying the blood first go to the big toe direction and then turn back around to the ankle. In addition, while a variety of prostheses have long been available for other joints, there were initially less manufacturers selling artificial ankles in Thailand. Because of this, severe ankle osteoarthritis in the past were mostly treated through ankle arthrodesis, or ankle fusion surgery, to fuse the ankle bones together. While this type of treatment allowed patients to be able to walk, they could not do so naturally or easily due to the stiffness of the ankle and the inability to move the joint as before, resulting in reduced quality of life.
It was also found that after ankle fusion surgery other joints in the body could begin to deteriorate more rapidly. These other joints could deteriorate within just 10 years after surgery, due to the fact that they had to bear more weight and provide motion to compensate for the inability of the fused ankle joint to do so.
Today, however, ankle arthroplasty is available as an excellent treatment option that allows patients to move their ankles and perform activities similar to before they underwent surgery as possible.
Ankle arthroplasty is an alternative treatment for those suffering from ankle osteoarthritis or degeneration of the ankle joints, whether resulting from accidental injury, rheumatoid arthritis, or cartilage damage, or from osteoporosis and ankle osteoarthritis in elderly patients.
Ankle replacement surgery began in Asia in 1970 for the treatment of patients with ankle issues caused by osteoarthritis or arthritis. Initial artificial ankle designs suffered from implant subsidence. In fact during a 5–12.5 year tracking period there was a failure rate between 8.3-50%.
Since that time, however, several studies have been carried out regarding ankle arthroplasty, and artificial ankle implants have been developed so that the materials used and the characteristics of the prosthetic components have been designed to be as similar to the human ankle as possible, resulting in much better adhesion between the artificial joint prosthesis and the patient’s bones without the need to affix it with cement. This was possibly achieved by applying the same technology used in knee and hip replacement surgery.
Additionally, ankle arthroplasty now allows for greater mobility and efficiency, allowing patients to walk more competently and more naturally, as well as to return to a variety of their pre-surgery activities as possible, including swimming, cycling, and jogging. Post-surgery impact is reduced and result in significant deterioration of nearby bones and joints as less as possible. Furthermore, if, after much use over a long period of time, the artificial ankle prostheses may begin to deteriorate, or if other ankle problems appear at a later date, the doctor can convert it to ankle fusion surgery.
In Thailand, Total Talar Prosthesis Replacement (TPR) was developed in 2013-2014 for the treatment of patients with a variety of ankle problems. Research began with patients suffering from severe arthritis or ankle disorders involving injuries of the hindfoot and ankle, which consists of four bones called the tibia, fibula, talus and calcaneus, but focusing on the injury or disorders of talus. This surgery involves removing the damaged talus, which is then forwarded to an engineer to calculate the correct ankle implant size using computerized tomography (CT) or the ankle implant size or shape can be retrieved from the contralateral talus via CT. An artificial ankle prosthesis is then created using titanium or stainless steel. After the prosthesis is surgically implanted patients continue with physical therapy in order to help them move more easily and naturally as possible.
For patients undergoing Total Ankle Replacement (TAR), which replaces both the tibial and the talar surfaces, or ankle bones, the physician must be sure to remove any unnecessary bone fragments and tissue.
In the case of surgeries that are not particularly complicated, patients may expect to recover within 4 weeks. If surgery requires additional steps or procedures, recovery may take longer, but should be no more than 6 weeks in total. During recovery, the patient should begin to practice walking and should start physical therapy under the supervision of a doctor, but should not place their weight on, or overly stress, the new artificial ankle. All patients should see a doctor for their first follow-up visit within 2 weeks of surgery. Subsequent visits can be spaced further apart at 6 weeks, 3 months, 6 months, and 1 year respectively. After that, the doctor may schedule annual appointments to assess the overall performance of the ankle joint and check for any signs of deterioration.
Ankle arthroplasty is becoming increasingly popular, particularly due to the fact that after surgery patients are able to walk quite well and regain an amount of flexibility in the ankle as possible, and can return to a variety of activities similar to pre-surgery levels as possible. Most importantly, people have the ability to carry out daily activities conveniently and without over-dependence on others, thus improving their overall quality of life.
Ankle arthroplasty may not be suitable for patients with certain medical conditions such as severe osteoporosis or diabetes with uncontrollable blood sugar levels. Insufficient blood supply to the feet or legs can result in ineffective treatment, may have an effect on the longevity of the ankle prosthesis, and could cause complications or other postoperative infections. That said, any patients interested in ankle arthroplasty should visit a doctor for a personalized diagnosis and consultation.
Chayanin Angthong, M.D.
Orthopedic Surgeon Specializing in Ankle and Foot Arthroplasty