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AM I A GOOD CANDIDATE FOR ANKLE REPLACEMENT SURGERY?

Q: I’m researching ankle replacement surgery and have consulted with two surgeons who both believe I’m a suitable candidate. I’ve also spoken to two patients who are pleased with their outcomes. I’m aware that it’s still a relatively new procedure with room for improvement. What should I be aware of before deciding to proceed?

A: Based on recent studies, such as one conducted by Duke University Medical Center, ankle replacement surgery, particularly using the Scandinavian Total Ankle Replacement (STAR) prosthesis, can offer significant benefits to the right candidates. The STAR prosthesis has been in use since the early 1980s and remains one of the most widely used implants for this procedure.

The study from Duke involved 82 patients over a 10-year period, all of whom received the STAR total ankle replacement. This study is particularly insightful because it looked at both the objective outcomes (like pain reduction, improved ankle motion, and overall function) and the patients’ subjective satisfaction and quality of life after surgery.

The results showed that most patients experienced notable improvements in motion, function, and quality of life. Walking became easier for the majority of patients, although the ability to run was not typically restored. Some patients continued to experience residual pain, and there were instances of infections, both on the surface and deeper within the joint.

It’s important to note that up to one-third of the patients in the study experienced a failure of the implant, requiring it to be removed. Common reasons for implant failure include loosening, fractures, and subsidence (where the implant sinks into the bone). Despite these risks, the overall implant survival rate was found to be 88.5% after 10 years.

One of the key takeaways from this study is that patients reported high levels of satisfaction with the surgery, despite some ongoing challenges. This positive feedback, coupled with measurable improvements in function and quality of life, suggests that for many, ankle replacement surgery can be a beneficial option.

However, it’s also crucial to understand that this is a complex and challenging procedure, with a higher risk of complications compared to other joint replacements like the hip or knee. Given this, surgeons are very selective about who they recommend for this surgery. If two surgeons have agreed that you are a good candidate, it’s a positive sign, but it’s also important to weigh the risks and benefits carefully.

If you decide to proceed, it would be advisable to work with a surgeon who has extensive experience with total ankle replacements and who can provide you with detailed information on what to expect during recovery and in the years following surgery.

Reference: James A. Nunley, MD, et al. Intermediate to Long-Term Outcomes of the STAR Total Ankle Replacement: The Patient Perspective. In The Journal of Bone and Joint Surgery. January 4, 2012. Vol. 94A. No. 1. Pp. 43-48.