Conditions & Treatments

Arthritis and Ankle Arthroplasty (Replacement)

Ankle arthroplasty or replacement is surgery to remove damaged bone and cartilage in the ankle, and replace these parts with artificial joints or prosthetics to replicate joint function, mobility, and stability. It is used to treat ankle pain caused by fractures and arthritis. Pain is due to the deterioration of cartilage, which causes the bones to rub together. Pain relief is the major reason for this surgery.

Surgical options for ankle arthritis include ankle fusion surgery or ankle replacement. In ankle fusion surgery, the worn-out joint is debrided and the bones are fused (permanently fastened together). It helps relieve pain, at the cost of lost mobility. The ankle loses up and down movement, which alters walking patterns, and puts greater stress on surrounding joints which can result in additional wear and tear, and pain in other parts of the foot. The single major advantage of ankle fusion surgery is that fusion will last a lifetime. Pain relief is similar with either procedure. Thus, when a patient does not qualify for ankle arthroplasty, fusion is a good option.

Today ankle replacement surgery is an option when an injured and arthritic ankle joint affects function and causes pain that can’t be relieved with medication.  Unlike ankle fusion, ankle replacement offers the advantage of preserving the ankle joint’s mobility, including the ability to move the ankle up and down, as well as pain- relief. Patients report that total ankle replacement provides significant improvement in their quality of life.

Ankle joint replacement surgery is a difficult and complex procedure which requires an orthopedic surgeon with significant training, skill and experience.  At South County Orthopedic Specialists (SCOS), Dr. Arash Aminian, MD is a Fellowship Trained foot and ankle specialist. Dr. Aminian treats adults with foot and ankle conditions resulting from sports injuries, fractures, arthritis and deformities.

Ankle biomechanics

The ankle Joint is called the tibio-talar joint. It is located where the lower leg bones – the tibia and fibula- and the top of the foot meet. While the ankle joint is relatively small it bears the body’s full weight.

The ankle and foot together perform complex functions that are fundamental to walking, daily activities, and every locomotion activity. It is a complex system of 26 bones, 33 joints and more than 100 muscles, tendons and ligaments. This system:

  • Supports body weight
  • Balance
  • Shock absorption
  • Locomotion and
  • Stability

For these reasons, implant technology has been challenging. New implant technology and surgical approaches have made ankle replacement a viable alternative to ankle fusion for many patients. Materials are now more improved and designed to reproduce normal ankle function; therefore results have been significantly improved for patients with pain and disability.

Patients in Orange County, California, can expect the best surgical experience with Dr. Aminian, who strives to provide the latest technical and surgical advancements to his patients for the best possible outcome.

Considerations for ankle replacement

When arthritis is localized to a small cartilage injury, pain may be improved with arthroscopy. Here a small camera is used to visualize the ankle and remove damaged tissue. This is minimally invasive and is only effective in the early stages of arthritis.

Ankle replacement surgery is appropriate for patients with severe ankle arthritis, for ankle injuries including fractures, and post- traumatic and inflammatory arthritis. When these conditions cause moderate to severe pain, loss of mobility, and loss of ankle function, joint replacement may be a good option.

However, not everyone with ankle arthritis is a candidate. Ankle replacement is not suitable for people with:

  • peripheral artery disease (poor circulation)
  • prior ankle infections
  • peripheral neuropathy or a loss of sensation in the feet
  • severe osteopenia and/or osteoporosis
  • heavy physical work
  • uncontrolled diabetes

Indications

  • Age- ideal candidates are middle aged and older with no significant comorbid disabilities, normal to low body mass, adequate bone, good soft tissue, and a stable, aligned foot.
  • Primary/Secondary Arthritis
  • Failed conservative treatments including bracing and anti-inflammatory medications

The only way to know whether you are a good candidate for ankle replacement surgery is to schedule a consultation with Dr. Aminian.

Ankle Replacement Surgery

Before surgery patients should plan modified work activities for 6 weeks after surgery. Patients should prepare for surgery so that they are in the best possible health before surgery, as this will also help during recovery.

The surgery usually takes about one and a half hours.  Pain management is a combination of oral medications and peripheral nerve blocks. A patient may be in the hospital overnight or may go home the same day.

During a consultation with Dr. Aminian, he will advise whether ankle replacement surgery is appropriate and explain implant options and his recommendations.

Durability of ankle prosthesis

A patient’s lifestyle has a major impact on the durability of ankle joint replacement implants. Patients are able to do some sports including golf, cycling, swimming and cross country skiing. When durability is a concern, an ankle replacement may not be a good option.

Modern implants (third generation) have significantly improved outcomes.  However, all implants have a limited life expectancy because they are subjected to wear and tear. There is a 80-90% survival rate for the total ankle replacements at 10 years.

SCOS and Dr. Aminian strive for compassionate, personalized care and treatment options geared to the patient’s personal needs, and goals. In Orange County, California SCOS and Dr. Aminian are the best choice for the care and treatment of foot and ankle disorders.


Foot & Ankle Specialists

Arash-Aminian,-MD-ThumbnailArash Aminian, MD

Dr. Arash Aminian specializes in the care and treatment of foot and ankle disorders at South County Orthopaedic Specialists. Read Dr. Aminian’s biography.


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