Total ankle replacement (TAR) is emerging as an increasingly attractive option for many patients with end-stage ankle arthritis. While ankle fusion was once considered the gold standard for severe arthritis, technological advances are positioning TAR as a viable alternative that preserves joint mobility without compromising long-term outcomes, according to experts at Baptist Health Orthopedic Care.
Justin Weatherall, M.D
“What’s really swung the pendulum is this fourth generation of implants,” said Justin Weatherall, M.D., a Baptist Health orthopedic surgeon who specializes in foot and ankle surgery. “We now have lower-profile implants, great fixation options, and longer implant survivorship, and we have a solution that is eliminating pain for our patients.”
Dr. Weatherall considers a patient a good candidate for an artificial ankle joint if they have:
- Advanced ankle arthritis (due to trauma or wear and tear)
- Pain that persists and is not responsive to conservative treatments
- A desire to preserve their ankle movement
- Overall good health with adequate bone quality
- Decided that they will not participate in high-impact sports
Generally, TAR patients are above the age of 50; however, Dr. Weatherall will perform the procedure on younger patients in certain circumstances.
At a Baptist Health Orthopedic Care Symposium, Dr. Weatherall reviewed many of the latest generation of implants. One study, “Two- to Five-Year Outcomes of Total Ankle Arthroplasty with the Infinity Fixed-Bearing Implant” followed nearly 500 patients and showed a two-year survivorship of 98.8 percent and a non-revision reoperation rate of 2.8 percent. The study was published in The Journal of Bone and Joint Surgery in 2023.
“With most of the implants, we are approaching acceptable survivorship rates,” Dr. Weatherall said. “Failures tend to happen within the first two years. If we get to two years, most studies show that the patient is going to keep the implant.” Physician researchers are working on collecting more data to help differentiate between options and guide them in making the best decision for each patient, particularly since new implants are being introduced to the market regularly.
Patients who are not ideal candidates for TAR include those who have:
- Uncontrolled diabetes
- Poor blood flow, which can make wound-healing difficult
- A bone infection such as osteomyelitis or had a suspected infection after an open ankle fracture or surgery
- Obesity
- Neuropathy
- Charcot foot or ankle
- Osteoporosis
- A desire to participate in high-impact activities
At the same symposium, orthopedic surgeon Cary Chapman, M.D., who specializes in foot and ankle surgery with Baptist Health Orthopedic Care, spoke about the latest advances in minimally invasive techniques.
Cary Chapman, M.D
“We are performing surgery through these small, percutaneous incisions without direct visualization and our goals are to have the same or better results as traditional surgery,” he said. “Studies show that with minimally invasive surgery there are fewer wound complications, less scarring, a faster recovery and return to work, less short-term pain and a reduction in the use of opioids.”
Dr. Chapman performs minimally invasive procedures such as bunion and hammertoe surgeries, cheilectomy surgery, calcaneal and medial lateral calcaneal surgery, sliding osteotomy and metatarsal osteotomy, among others.
“We are past the fad stage with minimally invasive surgery,” Dr. Chapman said. “This is the future.”
In addition to surgical options, physicians at Baptist Health Orthopedic Care offer biologic injections, hyaluronic acid injections and other conservative treatments, including physical therapy, braces, splints and pain management. For a referral to a Baptist Health Orthopedic Care doctor, call 786-268-6200.