Total Ankle Replacement – Dr. Joseph F. Galles
Dr. Joseph Galles discusses the total ankle replacement surgery.
How has total ankle replacement surgery evolved over the years?
Over the years treatment for ankle arthritis has evolved. More recently, more and more designs have come up specific to ankle replacements that I think are more amenable to treating patients today. So years ago, there were designs that I think we're not a great design; they tended to fail. More recently, there's been a lot of research and a lot of effort into making the ideal (ankle) implant for patients.
Who is an ideal candidate for a total ankle replacement?
Having said that not everyone is an ideal candidate for an ankle replacement. So someone who's in their 60s or older, not obese, relatively healthy – an individual who wants to play golf or doubles tennis would be an ideal person for ankle replacement.
How does total ankle replacement surgery work?
Most people are familiar with knee replacement surgery. It's essentially that type of implant that we've downsized to put it simplistically that goes into the ankle. We typically make the incision on the front of the ankle and you're in the hospital overnight.
What does the recovery look like from a total ankle replacement?
We ease into the weight-bearing usually starting at about two to four weeks after the surgery depending on the bone quality that we see intraoperatively. But it is a pretty quick recovery by and large – about half the recovery time of an ankle fusion in my experience,
How long does the ankle replacement last?
For the average patient, if we can get 15 years out of an ankle replacement, I would say that's a good outcome. The further away you get from the core of your body (meaning the further away from the center your body) there are more joint reactive forces going on. So the rule of thumb is every pound up above it translates to about seven pounds of pressure through the ankle, and about four and a half pounds of pressure through the knee.
So over time, even in ideal circumstances, the ankle will wear out. I've done ankle replacements on people as young as mid-50’s and I tell them that this is not going to be the last surgery they get in their ankle. Now if somebody is in their 70’s or 80’s, it may be – it all depends on the activity level they choose to pursue – as well as the other variables such as weight and other comorbidities that they may have. But if we can get 15 years out of an ankle replacement, that would be great.
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