Total Ankle Replacement Restores Function

Roger Dunn battled chronic ankle pain for decades, an unwelcome side effect of playing college football and repeat injuries over the years. Finally tired of “dragging it along,” Roger got an appointment close to home with foot and ankle surgeon Matthew Williams, DPM, at the Virginia Mason Kirkland Medical Center. Dr. Williams discussed a treatment option Roger never knew existed: total ankle replacement.

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Roger Dunn

“For years the gold standard for ankle arthritis was permanently fusing the joint, which relieves pain but decreases motion, leading to arthritis in nearby joints over time,” says Dr. Williams. “While earlier ankle replacement devices had high failure rates, recent advances in design and materials have significantly improved longevity and decreased complications.”

Roger needed no convincing to undergo the surgery, with his bone-on-bone ankle joint — the worst kind of daily grind. He scheduled the procedure, bracing for a long recovery and some next-level pain, but he was in for a big surprise.

“It just amazed the heck out of me that I never experienced any pain in the joint or in the surrounding tendons,” says Roger, who had the procedure in November 2018. “Once out of a cast I was religious about wearing my boot and not taking any chances. I went back to work on a knee scooter in two weeks, where I could also ride my desk chair around a bit.”

Soon Dr. Williams eased Roger off the scooter and into walking with a brace. Physical therapy helped keep Roger’s mobility on track, steadily improving his strength and balance. X-rays confirmed successful realignment of Roger’s foot, ankle and leg, something Roger never imagined possible with such an old, gnarled body, as he put it. What he didn’t know is everything that made his case unique informed a treatment plan designed for the best possible outcome.

“Before performing an ankle replacement, we use advanced computer programs to plan the surgical approach, building in correction for any existing deformity,” says Dr. Williams. “Sometimes it’s necessary to make corrections in stages to achieve the best function for patients. I also take great care when selecting patients who are likely to benefit from ankle replacement. Things like recreational activity level, age, occupation and body mass are all critical considerations for success.”

Roger wrapped up physical therapy a few months after surgery, feeling balanced and confident on his new ankle. A recent X-ray showing everything healed as expected told Roger he’s good to go. Now when it’s time to get a knee replacement on the other leg – another troubled joint destined for a fix – he’ll have the stability on the right to take whatever comes.

Would Roger recommend total ankle replacement to other people who wonder if it’s worth the time, bulky boot, scooter-cruising and physical therapy visits? Absolutely, he says.

“I was careful to follow all the rules of the road and was lucky I didn’t have any falls,” says Roger. “The no-pain part is what really worked for me. It wasn’t something Dr. Williams guaranteed going in, it’s something that happened because he’s an excellent surgeon.”


A version of this story also appears in the Virginia Mason Health System 2018 Annual Report.  

Chronic Ankle Pain? You May be a Candidate for Replacement

**By Eric Heit, DPM**

More than 30 years ago, Michael Diorio fell from a palm tree while trimming fronds at a San Diego apartment. The three-story fall crushed his left heel and fractured his right ankle. Over the years he’s had seven surgeries on his feet and suffered pain on a regular basis.

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Michael Diorio

After moving to the Pacific Northwest three years ago, Diorio, 56, was referred to a podiatrist with Virginia Mason Orthopedics and Sports Medicine. Diorio soon learned he was a candidate for a relatively new procedure – total ankle arthroplasty, also known as total ankle replacement. 

Last December Diorio underwent the three-hour outpatient surgery on his right ankle at Virginia Mason Hospital and Seattle Medical Center. He was able to return to full-time work in March, where he spends several hours a day on his feet.

“I used to limp and regularly experience pain,” says Diorio.  “Now I walk almost as well as I did before my injury and without any discomfort. I’m glad I was a candidate for total ankle replacement and have been very satisfied with the experience and outcome.”

The procedure

Total ankle replacement is similar to hip and knee replacements – patients receive a new ankle joint made of precisely engineered metal and plastic parts that replace the old ankle joint.

The surgery is typically performed without the need for an overnight hospital stay and patients usually go home the same day. Patients should expect a period of limited weight-bearing, followed by a gradual return to daily activity as their ankle heals. Most patients will have physical therapy after the procedure to help regain mobility.

The benefits — and some risks

Total ankle replacement relieves discomfort in the joint that older adults sometimes experience during weight-bearing activities. It might also ease occasional ankle pain when not moving the joint.

However, like every surgery, there are risks such as infection and wound healing problems, although this risk is low, occurring in less than 2 to 3 percent of cases.

The American Orthopaedic Foot & Ankle Society recommends people try non-surgical options for pain relief before considering total ankle replacement. Some patients get relief through treatments such as bracing, cortisone or steroid injections and changing to non-weight bearing or low-impact activities.

sr.coupleIf non-surgical approaches do not provide relief, total ankle replacement might be appropriate.

Getting the green light
Your physician will consider a few things before recommending surgery, such as:

  • Age
  • Activity level
  • Other potential medical complications
  • Severity of arthritis in your ankle
  • The potential for arthritis in other foot joints

In general, surgeons recommend total ankle replacement for people 55 or older. The thinking is that older adults will likely not stress the ankle as much as a younger patient, extending the life of the implant. Runners, or people who do other high-impact activities, are not good candidates for the surgery.

A person’s overall wellness before total ankle replacement is important. People should see their primary care physician before surgery to help ensure they are in optimal health.

Even if someone doesn’t think they’re a candidate for total ankle replacement, they  should get a referral from their primary care provider to consult with a foot surgeon. This is important because even if someone isn’t a candidate for the procedure, the specialist can discuss other treatment options that might help.

If you have health issues

Certain conditions can increase the risks associated with surgery and recovery, such as:

  • No ankle movement
  • Poor ankle-bone quality
  • Unstable ankle ligaments
  • Significant ankle alignment problem
  • Infection, especially in an ankle

If you have diabetes, your doctor will want to make sure you have good circulation and healthy blood-sugar levels before surgery. If your condition is not well-controlled, it increases the chance of complications, including infection.

Outcomes

According to the American Orthopaedic Foot & Ankle Society, there is a 90 to 95 percent chance that total ankle replacement will be successful and without complications.

Based on our experience at Virginia Mason, most people are doing well within about three months after surgery, and full recovery usually takes six months to a year.

Dr. Eric Heit


Eric Heit, DPM, is a board-certified podiatrist with Virginia Mason Orthopedics and Sports Medicine. His specialties include podiatry, foot and ankle surgery, podiatric surgery and sports medicine. He practices at Virginia Mason Hospital and Seattle Medical Center