Rheumatology: Current Research
Open Access
ISSN: 2161-1149 (Printed)
ISSN: 2161-1149 (Printed)
James K De Orio
Duke University Medical Center, USA
Posters & Accepted Abstracts: Rheumatology (Sunnyvale)
The replacement of the arthritic ankle with metal and plastic was first developed in the 1970s. However, significant failure of initial cemented ankle replacements discouraged surgeons and patients from pursuing this course of treatment. Now, however, prostheses used without cement have continued to evolve and are proving very reliable. With early and midterm results of newer ankle replacements reaching survival curves greater than 90%, more and more surgeons and patients are turning toward ankle replacement for relief. It has been shown that ankle replacements provide equal relief to an ankle fusion and unlike the ankle fusion, allow a significant amount of motion and do not jeopardize the subtalar and talonavicular joint nearly as much as the fusion. The two kinds of ankle replacements available for use are categorized as mobile and fixed bearing. As their name implies, mobile bearing polyethylene spacers are not fixed to either the tibial or the talar component whereas the fixed bearing ankles have the spacer fixed to the tibia. Current thought suggests the fixed bearings have the edge in terms of survivability. We have also learned to balance the ankle and to add additional hindfoot arthrodeses or ligament repair as necessary. Thus it is common to perform a lateral ligament reconstruction, gastrocnemius release, deltoid peel, subtalar arthrodesis, calcaneal osteotomy and a dorsiflexion osteotomy of the first metatarsal during the course of total ankle replacement to balance the ankle, increase range of motion and provide normal support for activities of daily living. Finally, the newest ankles have been developed to use CT scanning to create patient specific molds used at the time of surgery to ensure accurate alignment. Ankle replacements are here to stay..
Email: james.deorio@duke.edu