Hip and knee replacements total over three quarters of a million annually, but until now, ankle surgeries were rarely performed. Replacement techniques have changed dramatically in recent years and have given doctors new ways to repair painful, bone related conditions. While arthritis, bone fractures, and infections are treatable with this procedure, there are many other conditions that might require such a treatment.
|Craig Radnay, MD, demonstrates the INBONE Total Ankle to Andrew Keaveney, the first patient on Long Island to receive the prosthesis, at Franklin Hospital in Valley Stream. (Credit: ISK Institute)
Until recently, ankle surgeries were meant to relieve pain, and pins & screws were used to fuse the ankle to the foot, which limited mobility of the foot and prevented the ankle from pivoting. Because the ankle was restricted from moving freely, patients who continued to walk after surgery risked damage to the joint and bones, causing additional problems. This new approach to ankle replacement surgery involves the cutting out and replacing of bad portions of the three bones that intersect at the ankle. Surgeons can reshape these areas and attach a new artificial joint using a special bone glue. The joint is then reinforced with screws and a bone graft. Using the joint for the replacement ankle increases its mobility when the ankle heals, and the patients can resume their normal daily activities. The procedure also cuts down on further surgeries to fix problems that resulted from the former technique. The surgeon’s greatest challenge is properly aligning the ankle and foot to ensure that no stresses are present in the foot. The ankle supports the body’s entire weight, so maintaining balance is crucial.
The healing process is fairly easy compared to other surgeries. Patients will likely require a cast or splint and may sometimes need a drainage tube for a few days. After a few weeks of recovery, switching to a walking cast is possible, and basic physical therapy will sometimes be needed to get the patient accustomed to walking with new hardware and improving his/her gait. While additional surgeries are unlikely, it is possible the new joint can loosen and, in rare instances, require tightening. However, the failures of the device and the procedure are uncommon, and doctors are working diligently to increase the success rate even greater.
This new ankle replacement surgery costs about $40,000, but there are financial programs available to cover costs insurance won’t cover. The device has been approved by Medicare and other private insurance companies, but the procedure is fairly new, so many companies are still funding the old method and have yet to include the new procedure in their health plans. This is expected to change as the procedure gains popularity and the success numbers grow.