Patients with severe ankle arthritis often suffer from decreased quality of life, with significant pain, inflammation, and mobility issues. For many years, ankle fusion was the only surgical option for treating these patients. But thanks to advances in medical technology and surgical techniques, ankle replacement surgery has become a viable surgical alternative to eliminate ankle arthritis pain while maintaining joint mobility. Bucks County Orthopedic Specialists is proud to have Dr. Andrew Peacock, one of the area’s pre-eminent experts on ankle replacement surgery as part of its team. Recently we asked Dr. Peacock to share his knowledge and expertise on ankle replacement surgery. Here are excerpts from our wide-ranging conversation about the procedure, what it is, who can benefit from it, and how Dr. Peacock became the sought-after specialist in the area.
What is an ankle replacement?
It is the replacement of a damaged ankle joint with a prosthetic implant. Ankle replacement is a surgical option for patients with severe ankle arthritis that can alleviate pain, swelling, and inflammation while allowing the patient to retain some joint mobility. It is a viable alternative to ankle fusion surgery, which was previously the only option for advanced arthritis in the ankle.
Why would a patient need an ankle replacement?
Patients with end-stage or bone-on-bone arthritis of the ankle are candidates for ankle replacement surgery. In these patients, the smooth surface of the cartilage has worn away, causing pain and limiting mobility. Advanced ankle arthritis is typically the result of severe trauma or repeated injury to the ankle.
Why have most people never heard of ankle replacement surgery?
Ankle replacement has been around since the 1970s, but fell out of favor early on because the implant technology didn’t match that of knees and hips. Now companies are on the 3rd and 4th generation of implants for ankles. This new technology has been studied extensively, has high success rates and good longevity.
Another reason that ankle replacements are not well known is that there has been another surgical alternative for ankle arthritis, which is ankle fusion. While there are pros and cons to both ankle fusion and ankle replacement, the good news for patients with end-stage ankle arthritis is that they now have more options.
How do you know when it’s time for ankle replacement? What is the tipping point?
As a surgeon, I meet with the patient at an appointment and analyze their symptoms, lifestyle, and overall medical picture along with their imaging – x-rays and CT scans – to determine if they are a good candidate. Typically, we try to exhaust all non-surgical treatments such as anti-inflammatories, physical therapy and bracing before recommending surgery. When the ankle pain gets to be severe despite the other therapies, it’s probably time for surgery.
In ankle replacement – technically speaking – what are you replacing?
The ankle joint is made up of three bones, the tibia, the fibula, and the talus. In a replacement, two highly polished cobalt chrome steel parts – the tibial component and a talar component – along with a highly cross-linked polyethylene component are used to replace the ankle joint.
Who makes a good candidate for ankle replacement?
A good candidate for ankle replacement is usually someone over the age of 50, active – but not high-demand. An ankle replacement will allow patients to get back to activities like hiking, tennis, and things like that. We discourage running and jumping activities because that could wear out the replacement prematurely. For runners or basketball players – it’s not necessarily the best treatment option.
So, if you had ankle arthritis and wanted to keep running or playing basketball, what’s the best option?
Those patients would do better with an ankle fusion because it is more durable.
From a technological standpoint, how has ankle replacement surgery improved over the years?
Technically speaking the amount of bone that needs to be removed in newer generation implants tends to be less. Also, I use CT-guided implants, in which custom-made instrumentation and cutting guides help us to place the implant and shorten the surgery time.
How is CT technology used with the ankle replacement surgery?
In preparation for surgery, patients will get a CT scan of their ankle. The images from that scan enable me to create custom-designed instruments that will be used in the patient’s surgery. With the help of the engineers and these custom instruments, we are able to shorten the time of the surgery by about 45 minutes.
How did ankle replacements become one of your specialties? What led to your interest in it?
A lot of my foundational training was in reconstructive surgery and my fellowship was pretty much split between trauma and reconstructive surgery. The trauma half of things became a big part of my specialty, which in turn led to a lot of reconstructive surgery.
My high-volume fellowship launched me into total ankle replacements. It’s not something you want to dabble in; it’s something you want to be doing routinely to ensure the highest quality outcomes.
If you could let people know anything about ankle replacement surgery – what would it be?
The most important thing to know is that we have options for advanced ankle arthritis. It’s not just the proverbial – “you need to live with it and deal with it.” For the right patient, ankle replacement surgery will relieve pain, maintain motion, and allow them to get back to living a full, active life.