Total Ankle Arthroplasty Have We Made any Progress - David Thordarson, MD

This video is from the 2022 California Orthopaedic Association Annual Meeting. Click the link to see more videos from this course:
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[@ManfredBartz]

I am 71yo and have post traumatic arthritis in one ankle which limits dorsiflexion due to impingement and limits my ability to walk more than 5km per day because of increasing pain. In a consultation with an orthopaedic surgeon, he advised that the pain could be relieved by doing an ankle fusion and I would be able to maintain but not increase my current activity level. He does no longer do total ankle replacements (TAR) because the longevity of this is an average of only 8 years. In my case, he thinks that there is a high probability that I would out-last any TAR and require revision surgery if I wanted to pursue that option. After doing my own investigations, I came to the conclusion that current TARs start failing after 2 years, mostly due to bone erosion caused by wear-particles from the plastic component of the TAR. In the best cases, TARs can last up to 12 years. In some countries they are doing metal-on-metal or ceramic-on-ceramic TARs but that technology is also immature and metal particles can also cause bone erosion. The surgeon gave me a list of strategies to delay the need for a fusion and some of those might be useful. Not on the list was electro stimulation of cartilage growth but I am willing to experiment with that on my own. Also missing from the list was TENS treatment. It turns out that arthritis.org has an article "Electrical Nerve Stimulation for Arthritis Pain" and I can confirm that TENS treatment of the arthritic joint significantly reduces the pain -- YMMV.

[@JerryMccauley-j2x]

Had an ankle fusion in 2019, was a total failure with constant pain while walking. Had a TAR done in April of this year, after 4 weeks I was walking with very little pain. Ready for six month checkup next week and after months of PT I’m probably at 80% total recovery. Feels good to be able to walk pain free and my quality of life is improving everyday.

[@neilmiller6405]

It's a good operation but a lot could go wrong. Yikes!

[@higginsalb]

I did as much research on my total ankle replacement. I have had 2 in 2 years time. The first infection, removed install the old style, that went Higher up in the bone. My body has rejected it. Had to go to an allergist to have my back covered with test strips. I had my surgery done both times at Duke University hospital. I could write pages an pages on this. I can not walk in constant pain and at night it is so bad I can’t walk. PLEASE anyone think of do it. DON’t do it.

[@Akonovo]

So, you dont recommend ankle replacement? i have a 4th grade arthrosis and im thinking about ankle replacement, but im 34yrs and im not sure about long term with that ankle prothesis

[@PatchPixels]

​@@AkonovoHey, I'm also 34 and in constant pain from post traumatic arthritis in my ankle. Have been told that a TAR is totally off the table due to my age and activity level - and have been told fusion is my only option. It's very daunting stuff. Let me know how you get on (if you want). Best of luck to you!

[@ErinMTexas]

​@@PatchPixels - I just had TAR two days ago - going home from the hospital today. My doc did rhe the inbone syatem because my ankle was so degraded no cartlidge, bone cysts, swelling, he called it severe. All this to say is DO IT - if your doc recommends it. The day after surgery was very painful, but all normal the next day.

[@ManfredBartz]

@@Akonovo, if you look at the big picture, e.g.the 5 decades of life agead of you, what do you think the likelyhood is of a biological cure emerging during that time? I suspect it would be very high. Maybe cartilage will be able to be regenerated much sooner, possibly in the next 10 years. If you go for a TAR you give up the chance for a biological cure. And given that TARs only last an average of 8 years, are you comfortable with having 5 or 6 TARs? Is that even possible? Most likely, after the second TAR fails it will have to be a fusion -- and with a big hole where the joint was, that won't be easy. Also see my other comment to this video.

[@ErinMTexas]

@RickFlanagan that is good to know!! I start PT soon and am looking forward to walking normally again - I pray. A year to feel normal again? Which system do you think worked better for you?