Johns Hopkins Health Alert
Which Should You Choose: Ankle Fusion or Ankle Replacement?
Joint replacements have become commonplace for people with severe arthritis of the hip, knee or shoulder. What you many not know, though, is that joint replacement is also an option when arthritis affects the ankle. Recent research suggests that ankle replacement is at least as effective as ankle fusion -- the traditional surgical treatment for ankle arthritis -- but both procedures have advantages and disadvantages that must be considered when making a decision.
- Ankle Fusion. People with severe ankle arthritis have traditionally opted for joint fusion surgery (arthrodesis). During this procedure, surgeons completely remove the ankle. The fibula (calf bone), tibia (shin bone) and talus (foot bone) are then fused together with metal screws.
Ankle fusion is very effective at stopping the pain of arthritis and stabilizing the bones so that they do not rub against one another. However, the ankle remains permanently stiff, restricting range of motion. Over time, arthritis may also develop in areas of the foot as other joints compensate for the ankle's loss of motion. And because the ankle joint has been completely removed, it may be difficult to bend down, climb stairs or walk on uneven surfaces.
Ankle fusion has the advantage of durability: It is permanent and will withstand the rigors of strenuous physical activity. As such, the procedure may be a good choice for people engaged in activities or occupations that are very physical.
- Ankle Arthroplasty. Total ankle replacement or ankle arthroplasty was developed in the 1970s as an alternative to joint fusion. Ankle arthroplasty, which entails removing the arthritic joint and replacing it with an artificial one, fell out of favor because the artificial joints then in use malfunctioned frequently and wore out quickly. Often, they also failed to alleviate pain and restore ankle function.
Today, artificial ankle joints are more sophisticated and effective than past devices. The newest joints make use of a special porous coating that allows bone to grow into it to secure the joint. Current ankle devices also have more maneuverable components for better joint function, and the materials are much more durable than before.
In the past few years, the U.S. Food and Drug Administration (FDA) has approved three new ankle replacement devices, and research on these new artificial joints suggests that the outcomes of ankle replacement and joint fusion are similar. Both alternatives provide satisfactory outcomes for about 70 percent of those who undergo the procedures. The most appropriate procedure for each person is likely to vary based on individual patient factors and expectations.
Posted in Arthritis on February 6, 2012
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