Lifewatch: Custom ankle replacement

Reported by Claire Hosmann - bio|email
Posted by Debra Worley - email

(WECT) - Two million people visit the doctor each year for pain from ankle arthritis or fractures.

For some, ankle fusion was the only option to ease the pain, but it makes the ankle stiff.  Now, a personalized ankle replacement could be the answer for those who want to put the spring back in their step.

A stroll in the park with her granddaughter is a simple pleasure Janis Taylor never takes for granted.  A fall that lead to a broken ankle more than 14 years ago was the beginning of a painful journey.

"My foot ended up on my knee and broke bones in the bottom of my leg," said Taylor.

Two ankle replacements failed, and she was confined to a wheelchair.  That's when Taylor turned to Dr. Mark Myerson, a foot and ankle reconstruction expert who's helped many professional athletes get back into form.

Myerson creates customized ankle replacements for his patients.

Traditional replacements are smaller and depend on support from the ankle.  The problem with that is sometimes the bones shatter under the pressure.

Myerson's design extends deep into the heel bone, stabilizing the foot and preventing collapse.

"We can build this up into any custom device we want and now salvage the ankles that were previously non-correctable at all," said Myerson.

Before finding Myerson, Taylor's options were either amputation or ankle fusion, where plates and screws fuse the bones together.  It relieves pain, but leaves the joint stiff, limits movement, and would have shortened Taylor's leg by 1.5 inches.

With the customized replacement, her ankle is flexible and has only lost a quarter inch of her height.

Good candidates for the ankle replacement have had an unsuccessful ankle replacement in the past of have soft bones.  After the replacement, patients have to stay away from impact activities, but can still be active.

For more information, please contact:
Mercy Medical Center
Baltimore, MD

BACKGROUND: Thirty years ago, total ankle replacement surgery was not a successful option for patients. Almost all of the devices implanted ultimately failed. Physicians primarily treated ankle arthritis and fractures with casting. This often resulted in more arthritis in the ankle. The aging population and the resulting baby boomer generation being healthier and more active has resulted in more cases of degenerative age-related arthritis. The numbers of patients with osteoarthritis of the ankle will likely continue to grow as patients live longer and want to be active for longer periods. The design of the prosthesis began to improve in the late 1980s and within the past ten years ankle replacement became a viable option for patients.

ANKLE FUSION: For some patients, one of the alternatives to total ankle replacement is ankle fusion. This involves implanting metal implants to hold the ankle bones together. The bone surfaces heal in this position and the joint is permanently stiff, although the result is usually a pain-free joint.

TOTAL ANKLE REPLACEMENT: The main advantage of total ankle replacement is the return of some flexibility in the ankle. This movement is important for walking, exercising and climbing. Full movement of the ankle joint is never regained even with the surgery. However, much more movement is gained with a successful ankle replacement compared to an ankle fusion. Sometimes problems arise later when the joints begin to take the brunt of the force in the foot. That's when arthritis starts to develop.

CUSTOMIZED ANKLE PROSTHESIS: For people who've suffered through several failed ankle replacements or for those who have soft bones, a customized ankle replacement may be a good option. Mark Myerson, M.D., an orthopedic surgeon at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, MD, has developed an implant that extends deep into the heel bone. A typical prosthesis has a very small stem that can cause the ankle to collapse under the pressure of the foot. Dr. Myerson customizes the stem of his implant for each patient. If there is bone loss, damage or dead bone he builds up the prosthesis so that it sits all the way into the heel bone and is supported by the entire back of the foot, not just the ankle. "It's a very clever device that allows patients to have an ankle replacement who otherwise would not be suitable candidates for this procedure," Dr. Myerson told Ivanhoe. Dr. Myerson has been implanting his devices for about six years. "Certainly in the short term the complication rate and the failure rate has been significantly less, so it's very exciting to see over the course of the next decade to see how these will outlive the more standard ankle replacement," he said.

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