Total Ankle Replacement
The purpose of a total ankle is to relieve pain in the ankle while still allowing the ankle move. Usually this type of pain is caused by arthritis, a condition that can take many forms and may go by many names, including osteoarthritis, post-traumatic arthritis, and rheumatoid arthritis.
Ankle Fusion vs. Total Ankle Replacement
When an ankle is fused, the joint is removed and the tibia and talus heal together to make one bone. This results in good pain relief, but no motion at the ankle joint. When an ankle is replaced, the joint is removed and replaced with metal and plastic components. These components maintain joint motion. One of the major benefits of having motion at the ankle joint is that it relieves pressure on adjacent joints of the foot and ankle and we believe lessens the propensity for degenerative arthritis of these joints. Likewise, the ability to move the ankle 25 to 35 degrees is critically important to having a normal gait pattern. Activities such as walking up or down a slope, walking on uneven ground, golfing, and hiking are more difficult with a fused ankle than with a mobile ankle.
Choice of Implant/Total Ankle System
Dr. Kemp is currently utilizing multiple ankle replacement systems. He will customize your care with the implant that is right for you, in order to reach the best possible outcome. He is the only surgeon in the state of Idaho trained on all of the most cutting edge implants, including the S.T.A.R. total ankle, InBone total ankle, Infinity total ankle, and the Prophecy computer guided total ankle system. This choice is important to you as a patient, because each implant has it's strengths and weaknesses. Therefore, one implant may be right for you and the others may not.
Inbone Total Ankle
Since its inception in 2005, the INBONE® Total Ankle System has continued to be the most distinctive and innovative total ankle replacement system on the market. By offering the first total ankle system that provides intramedullary instrumentation (utilizing the vertical axis of a patient’s shinbone) for accurate component positioning and the first ankle prosthesis with a modular components for patient specific needs, Wright Medical continues to redefine innovation in ankle arthroplasty.
Infinity Total Ankle
The INFINITY® Ankle is the newest addition to the Wright Medical total ankle portfolio. INFINITY® is a low-profile implant, optimized for the efficiency and accuracy of PROPHECY® Preoperative Navigation. INFINITY® builds upon the solid foundation of INBONE® to position Wright Medical as a continuous innovator in the field of ankle arthroplasty.
The INFINITY® prosthesis was purposefully designed without tibial flanges or barrels and without talar dome side walls that would obscure fluoroscopic imaging. By allowing complete visualization of the implant interface, the surgeon can verify thorough seating of the prosthesis. This important feature also facilitates the visibility of X-rays for post-op follow up.
Prophecy Computer Guidence
PROPHECY® Preoperative Navigation Guides have ushered in a new era of total ankle replacement. Through the combination of computer imaging and the patient’s own CT scan, a customized plan can be developed for your own unique anatomy, in advance of your ankle replacement surgery.
The FIRST and ONLY Preoperative Navigation for Total Ankle Arthroplasty.
PROPHECY® guides provide the alignment accuracy of the traditional INBONE® and INFINITY® Total Ankle Systems while reducing surgical steps.
Patients may benefit from the following:
- Patient-specific instrumentation
- Crucial anatomic landmarks identified before your surgery
The Scandinavian Total Ankle Replacement (S.T.A.R.)
The S.T.A.R. total ankle system, which was developed by Dr. Hakon Kofoed of Denmark is one of the implants Dr. Kemp uses.
The S.T.A.R. Total Ankle is unique because of its design. It is the only ankle replacement of it’s kind being used in the United States. What makes it unique is its 3-part design, instead of just two parts like most ankle replacements currently available. It is an unconstrained mobile bearing device, which basically means that the ankle replacement mimics your natural motion compared to other types of ankle replacements.
The S.T.A.R. ankle is the only 3-part ankle replacement system that is approved by the FDA. The FDA approved it for use in June of 2009. In addition, the American Academy of Foot and Ankle Surgeons (AOFAS) have deemed total ankle replacement as an acceptable alternative to ankle arthrodesis in the proper patient population.
During your preoperative evaluation you and Dr. Kemp will review all of your records and existing x-rays, MRIs, and CT scans. Even if you have existing x-rays, your visit will include new standing x-rays of your ankle joint.
Once you and Dr. Kemp have decided that you are a good candidate for total ankle replacement, we will arrange a surgery date. While you are in the clinic, we will ask you to sign a consent form for your surgery and answer any questions that you may have regarding the surgery and your recovery.
The Surgical Procedure
Total ankle replacement is performed in an in-patient setting at one of the hospitals in Boise. Depending upon the your age, medical conditions, whether you live locally or at a distance, as well as several other factors, determine how long you stay in the hospital. Typically a overnight stay is routine.
The procedure is performed in the operating room. You typically receive a general anesthetic. A nerve block is used for postoperative pain control as well. The procedure lasts usually less than 2 hours. After surgery you will go to the recovery room for a few hours and then to your regular patient room. You will have a nasal cannula (tube) delivering oxygen to you until you are discharged from the hospital to help with wound healing. Transfusions are not used as the procedure is done under a tourniquet. Sometimes added procedures accompany the total ankle replacement such as lengthening of a tight Achilles' tendon, hardware removal, or fixation of weak bone.
You will receive 24 hours nursing care from the highly skilled nurses at the hospital. Dr. Kemp or one of his team will see you every morning to make sure your stay is going well.
It is very important to elevate your leg above your heart for the first 3 weeks. Elevation helps prevent significant pain and helps the wound heal.
During your hospital stay we will control your pain and to teach you to walk with crutches or a walker while not bearing weight on the ankle.
Physical therapy is performed once or twice daily to make sure you can safely ambulate non-weight bearing at the time of discharge. At the time of discharge, appropriate analgesics will provided for use at home.
Follow Up Care After Hospitalization
Your ankle is usually immobilized for six weeks in a cast or velcro boot. You will not be able to bear weight during the first three weeks and will need to use crutches, a walker, or a roll-a-bout. The cast is utilized to promote wound healing and to protect your new ankle. At the first visit to the office at 5-10 days after surgery, wounds are checked and new cast is placed. At 3 weeks post op, sutures are removed and a velcro boot is placed. You are allowed to perform gentle range of motion of the ankle at this point.
At six weeks following surgery you are allowed to start weight bearing in the boot. At this time, physical therapy is begun.
At 10 weeks, you will be placed into a lace up ankle brace and continue PT.
Further follow-up after 10 weeks depends upon individual patients. Usually a a six-month visit and yearly visits are recommended to check on motion and to ensure no other problems are developing. Necessary visits after surgery are at 5 to 10 days, 3 weeks, 6 weeks, 10 weeks, six months and yearly after that.
Scheduling an Appointment
Should you wish to proceed with an evaluation at our office, feel free to call 208-855-2410 to schedule an appointment. Any radiographs, scans, or pertinent medical information will be helpful. Usually at least two visits are required prior to scheduling surgery. The complexities of planning the surgery, and determining whether you qualify for a total ankle takes some time and we want to make sure that you have all of the information and time to think about your decision.
Likewise insurance authorization can be a time consuming process. Follow up appointments are necessary and required. You will not be able to come to Boise for surgery and then expect to have your follow-up care done elsewhere. We will need to see you for follow-up at our office. Minimum follow up is at 3 weeks, 6 weeks, 6 months, and 1 year after surgery.
Below are links to more information including a patient brochure, the FDA approval, a story featured in Horizon Airlines Magazine titled “Special Treatment,” the history of the S.T.A.R. Ankle, the AOFAS position statement, evidence supporting the S.T.A.R. Ankle, and technical documents. We hope that these help to educate you on this ground breaking and successful option for treating your ankle pain.
Click on the links below for more information on total ankles