Compared to replacements of the knee or hip joints, ankle replacement has been less common. Previous ankle replacement technology was modeled after knee and hip replacement technology. "The majority of ankle replacements in the 1980s failed because people didn't appreciate the difference of the ankle anatomy compared to knee and hip anatomy," said Brian Donley, vice chair of the department of orthopaedic surgery at the Cleveland Clinic in Ohio.
Dr. Donley helped design and win FDA approval for Salto Talaris Anatomic Ankle, a new total ankle replacement that mimics the anatomy and movement of a natural ankle joint. He was the first doctor in the United States to perform an ankle replacement using the new technique -- one, he says, that is not only better for the patient, but for the surgeon as well. Dr. Donley said the results are more reproducible and predictable, improving the chances for long-term success.
"We designed this new technology with the goal of offering better natural movement and greater comfort with the active patient in mind," said Dr. Donley.
The new device is used to treat patients suffering from arthritic conditions like rheumatoid arthritis, post traumatic arthritis, osteoarthritis, or a previous ankle surgery that failed. Arthritis can cause pain, loss of movement and swelling. Rheumatoid arthritis is one of the most serious types of arthritis. It is an autoimmune disease that mostly affects women and causes the lining of the joints to become inflamed.
The new ankle replacement option is designed to preserve more of a patient's original bone and allow them to move more naturally and feel less pain compared to traditional replacement methods. Only a small incision is needed for the smaller ankle prosthesis, which does not require fusion of the leg bones.
According to Dr. Donley, the end of the tibia -- a leg bone -- and the top of the talus -- the ankle bone -- are shaved down. Then, one of the two components of the prosthesis is attached to the talus bone and the other is attached to the tibia. A plastic piece is inserted between the two components to prevent them from rubbing.
"The critical part of an ankle replacement is that they have to be perfectly aligned in order to allow normal motion of the ankle and to decrease the chance of the artificial joint wearing out," said Dr. Donley. The device is made of polyethylene and chromium alloy and is available in three sizes.
According to the Arthritis Foundation, in 2006, roughly one in five adults in the United States had arthritis, or 46 million people. From 1985 to 2006, the number of people suffering from the condition increased by 11 million. Each year, arthritis costs the United States economy $128 billion. Patients whose conditions are severely debilitating may have damaged ankle joints, requiring ankle replacement.
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