Ankle Clinic

From A2FWiki


Friday, July 30, 2010	Enquiry line: (+44)(0)113 2185908/09	Email: Nick Harris

1 Ankle Replacement
2 Total Ankle Replacement Results
3 Other Ankle Procedures
4 Ankle Conditions
- 4.1 Ankle Arthritis
- 4.2 Ankle Instability
5 FAQ

Ankle Replacement

Total Ankle Replacement System

Ankle replacement as a treatment for end stage ankle arthritis is becoming increasingly popular as the results continue to improve.

Leeds has become a centre of excellence for ankle replacement both nationally and internationally over the last 5 years. We have performed over 200 replacements. We have submitted our early results for publication. Our success rate for the first 140 replacements was 97% at a mean of 20 months follow-up(range 6 months - 4 years).

We currently use the Mobility Total Ankle Replacement (DePuy) which is a three component mobile bearing design similar to the AES and Beucchal Pappas.

Total Ankle Replacement Surgical Technique

Mr Harris demonstrates The AES Ankle Replacement Surgical Technique through this in depth movie clip.

Total Ankle Replacement Surgical Technique
(Quicktime Movie Format:64MB)

Total Ankle Replacement Surgical Technique
(Windows Movie Format:50MB)

Total Ankle Replacement Results

Total ankle replacement: The early results of 140 consecutive cases of the AES prosthesis

Abstract
Between 2003 and 2006 we implanted 140 mobile bearing AES total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was 20 months (6 – 48). The mean AOFAS ankle and hindfoot score was 79 and 97% of patients rated their outcome as better, much better or excellent. A complication requiring further surgery developed in twenty ankles. At the time of follow up no implant had been revised or removed. The most frequent complication requiring surgery was edge loading in sixteen ankles. Other complications include delayed wound healing and fracture of a malleolus.

Total Ankle Replacement Results
(Adobe PDF Format:1.7MB)

Total Ankle Replacement Results
(Word Document Format:5MB)

Other Ankle Procedures

Ankle Fusion

Ankle fusion has been the traditional way of managing ankle arthritis. By fusing the joint the pain that patients experience is significantly reduced or abolished. Although the ankle joint is fused stiff with screws patients retain a surprising amount of movement in the foot. Ankle fusion remains the gold standard in managing patients with end stage arthritis with associated severe deformity and or neurological disorders.

Anthroscopic Ankle Fusion

Arthroscopic fusion is a less invasive way of performing a fusion and some surgeons believe this leads to a quicker recovery. The operation is performed through small incisions using arthroscopic instruments rather than the more conventional open fusion requiring larger incisions.

Ankle Arthroscopy

Figure shows arthroscopic debridement of osteochondral injury.

Ankle arthroscopy is a technique where a camera is placed inside the ankle joint. This allows direct visualisation of the joint to assess any pathology. It is also possible to treat some conditions arthroscopically such as osteochondral injuries (where the cartilage in the joint is damaged) and impingement by resecting bony spurs.

Ankle stabilization procedures

Ankle Stabilization combining anatomic and non-anatomic procedures.

Ankle stabilization procedures can be broadly divided into anatomic and non-anatomic. Anatomic stabilization procedures try to repair the existing ligaments. When these are severely damaged it may be necessary to perform a non-anatomic repair using a tendon transfer. Sometimes it is possible to combine both as in the illustration. The suture repairs the existing ligaments whilst the tendon transfer re-inforces them.

Ankle Conditions

Ankle Arthritis

Primary ankle arthritis is rare,the commonest cause is post traumatic. Other causes include inflammatory arthropathies such as rheumatoid arthritis and psoriasis and also haemophilia. Patients usually present with pain and stiffness and sometimes instability. Treatment initially consists of anti-inflammatories, modification of activity and orthotics. Should these fail there are a number of surgical options including initially a debridement of the ankle. The definitive treatments are either an arthrodesis or an arthroplasty. Other options include lateral ligament reconstruction in cases of lateral instability and early medial compartment arthritis. Joint distraction with an Llizarov construct and corrective osteotomies have also been described.

These xrays show the results of severe ankle arthritis treated by a total Ankle Replacement.

Severe ankle arthritis

Severe ankle arthritis treated by a total ankle replacement

Ankle Instability

Illustration showing stress x-rays of an unstable ankle

Inversion injuries to the ankle are the commonest sporting injury - approximately 6,000 injuries occur each day in the UK. The anterior talo-fibular ligament is the most commonly injured ligament. Treatment in most instances is functional and the majority of patients make an excellent recovery. Persistent instability leading to recurrent sprains and chondral injuries are the two most common causes for persistent symptoms. Persistent instability can be treated surgically in most instances by an anatomic repair of the ligaments. The management of chondral injuries is more difficult. Debridement, drilling and osteochondral autografts have all been described.

FAQ

Am I suitable for an ankle replacement ?

To find out if you are suitable for a replacement you need to be seen by an orthopaedic surgeon with a specialist interest in Foot and Ankle Surgery. Most hospitals now have dedicated orthopaedic foot and ankle surgeons. Alternatively we would be happy to see you in Leeds.

How long am I in Hospital ?

You usually remain in hospital for 5-7 days after the operation.

How long does the operation take ?

The operation usually takes approximately 2 hours. A movie is available of this surgery.

What is the post-operative rehabilitation ?

All patients are immobilised in plaster for the first two weeks post-operatively.Then depending on the degree of pre-operative deformity patients will either go into a walker boot or alternatively another plaster. At 6 weeks most patients are fully weight bearing. The ankle often remains swollen for a number of months post-operatively but this eventually settles.