Healthbeat Segment: Repair or Replace

January 21, 2011 4:25:57 AM PST
With baby boomers playing harder and living longer, replacing worn-out joints is more common than ever.

Ankle replacement, also called ankle arthroplasty, is gaining in popularity. The complexity of this joint makes it a tough one to successfully replace. Now, a new generation of devices is helping to keep people moving.

Some patients are discovering insurance companies cover hip and knee replacements -- but not too many ankles.

Cindy Rizzo wants to keep up with her young children. But even the simplest of activities can be painful. Four years ago, a misstep on the sidewalk changed her life.

"It happened so fast and everything shattered, and I felt it all at once crack, pop and it was done," Rizzo told ABC7.

Her ankle was broken and tendons were torn. Emergency surgery left her with a plate and seven screws.

Rizzo says she now lives with near constant pain from arthritis in the ankle and the realization that she can't do what other 51-year-olds can.

"I have my good days and bad days," she said.

Rizzo knew another surgery was in her future. Research and consultations convinced her an ankle replacement would give her a better quality of life. It involves using artificial joints that are implanted into the bone. But her insurance company denied coverage. That's because some insurance carriers don't consider it a viable option if you're under 65.

"The older patients can get them but I can't because I'm too young," said Rizzo.

Dr. Steven Haddad, an orthopedic surgeon at the Illinois Bone and Joint Instituteis, is Rizzo's doctor and says the dilemma is all too familiar.

"Ironically, working with Medicare is actually the easiest thing to do with an ankle replacement," said Dr. Haddad.

In patients 65 and older, it's thought the device is less likely to need to be replaced. Over time, the prothesis can wear out, so a younger patient could face multiple surgeries.

Still, some see replacement as a better choice. Until lately, ankle fusion was the only surgical option. The bones are permanently locked together with screws and most patients can then walk and move around without pain. But the catch is some mobility in the ankle is lost and that may put stress on other joints, leading to arthritis. The plus: it's very often a one time surgery and is considered quite durable.

"You would be surprised by the mobility of the remaining joints. That's not to say you don't have more motion with an ankle replacement. But it's not that we are welding the whole foot together. It's just the ankle," said Dr. Steven Kodros, orthopaedic surgeon, Northwestern Memorial Hospital.

Proponents say in the right patient total ankle replacement has benefits over fusion.

"It does take the stress off the adjacent joint surfaces. So that doesn't put that pain or arthritic pain there. It also allows patients to walk with a fluid walk or gait pattern," said Dr. Haddad.

The devices have changed over the years but durability is an issue. Dr. Haddad says these devices can last eight to 10 years or longer. The hope is newer ones will last longer. Rizzo plans to keep trying for the replacement.

"I need mobility. I have two young children and I need to get around," she said.

Dr. Haddad is a paid consultant for Wright Medical Technologies which makes ankle replacement devices.

There are currently four different devices now FDA approved and there are some insurance companies that will cover this procedure, depending on the patients situation. And coverage issue aside, patients with foot deformities or uncontrolled diabetes may not be candidates for ankle replacement at all.

American Academy of Foot and Ankle Society

Dr. Steven Haddad
Illinois Bone and Joint Institute
Glenview Illinois Bone & Joint Institute, LLC
2401 Ravine Way
Glenview, IL 60025

Dr. Steven Kodros
Northwestern Orthopaedic Institute, LLC
680 N. Lake Shore Dr.
Chicago, IL 60611
2501 Compass Road Suite 924 Suite 125
Glenview, IL 60026
Work Phone (312) 664-6848