Ankle Replacement / Ankle Arthritis

1anklerepl12anklereplTotal ankle replacement has dramatically improved in the past 20 years. The first generation of total ankle replacements gained popularity in the early to mid 1970’s. Over time, the implants were found to have poor construction and design and also had problems with poor quality plastic material that would deteriorate at a rapid pace. This caused the implant to fail.

In the past 20 years, a great deal of additional research and emphasis has been placed into ankle replacement. As the population ages, there is a greater need for replacement surgery and the ankle is no exception. The additional research on the ankle joint has allowed for improved implants and better implant materials allowing ankle replacement cases to dramatically improve in quality and longevity.

Current Ankle Replacement Implant Choices:

The current choices in ankle replacement are divided into three implants each with specific designs. The implants consist of the InBone (Wright) ankle replacement, The Salto Talaris (Tornier) ankle replacement and the Agility (Depuy) ankle replacement. All three of these implants are being used in the United States Currently, but they each have certain advantages and disadvantages.

The Salto Talaris-Tornier System

The Salto Talaris Ankle Replacement Implant Allows for minimal joint removal which can be changed to a fusion if the implant fails.

This ankle implant has been used in Europe for over 15 years and in the United States in the past 10 years. The Salto Talaris Tornier ankle replacement system is an excellent implant with very good structure, ease of implantation and low profile.

The benefit of a low profile implant is that there is less bone removal to put the implant in. This allows for easier transition to an ankle fusion in the case of a problem. The implant has been well designed and holds up well under moderate stress. There is no resurfacing of medial of lateral malleolus with this implant.

The Agility Ankle Replacement is ideal for patients with gutter arthritis. The implant is challenging to place but very stable due to the fusion of the end of the tibia and fibula

The Agility Depuy Implant

The Agility implant is the longest running of the new generation ankle implants in the United States. It has had a great deal of associated research and has a very good company background. The implant can be custom designed for severe deformities and also resurfaces the medial and lateral malleolus surfaces.

The Agility is a difficult implant to insert. There is a need for removal of part of the medial and lateral malleolus which can cause stress fracture. There is also a need for fusion of the end of the tibia and fibula to each other which is challenging and can cause the implant to fail if unsuccessful. The Agility does have a revision system in place currently and a new generation called Mobility is coming which is a three piece system with a mobile bearing joint. Although Depuy is an excellent company, the Agility is used by us in cases which require resurfacing of the medial and lateral malleolar gutters.

The Inbone Wright ankle replacement has an extra long stem for better control and improved function.

The InBone Wright Implant

The InBone system is based on the design for implantation in the knee. With knee implants, there is a rod used as a guidance system to allow for proper central placement of the implant. The InBone system allows for the use of a guidance system to better align and place the implant. By using a guidance system, the bone cuts are more accurate and the implant is better fitted. This allows for less shifting of the implant and more longevity. The problem with the InBone system has been the need for more bone removal. This is however a small concern compared to the excellent guidance system and the improved placement of the implant. The plastic in the InBone ankle replacement is also the widest one found which improves wear on the implant and reduces the potential for implant failure.

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The InBone ankle replacement has multiple pieces to allow for better patient fit and more replacement options. The cutting guide for ankle replacement associated with the InBone system allows for more accurate positioning of the ankle and more accurate ankle replacement.
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Guide for implant placement to allow for proper positioning of the implant and more accurate cutting of the bones.
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Placement of jig for bone cut Reaming of the bone after cut for implant placement
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Lateral and anterior posterior view of the final implant placement. Note the long shaft for better stability.

Which Implant is Best?

Each implant has good and bad qualities. In simple cases with no deformity and an older patient with little use of the ankle, the Salto Talaris implant is an excellent option. In severe arthritis cases involving the medial and lateral gutter, the Agility is an excellent option. In most cases with any deformity and with an active individual, the InBone system is an ideal option.

Who is a Candidate for Ankle Replacement?

The ideal candidate has a well positioned ankle joint without major deformity. The ankle joint has some motion which is painful. The less the motion, the less the motion will be after surgery. The age for ankle implants is relative but 55 years and older is preferred. Implants have been placed in individuals as young as 25, yet the ideal age is 55. Patients who require heavy lifting or heavy use of the ankle are not good candidates for surgery and may do better with a fusion procedure. Walking, running, golf and even tennis are okay after implantation of an ankle implant.


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