May 2010

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Do Age And Weight Factor Into Success With Total Ankle Replacements?

By Brian McCurdy, Senior Editor

In recent years, surgeons have looked to total ankle replacements to abate pain caused by such conditions as ankle arthritis. A recent study in the Journal of Foot and Ankle Surgery examines which patient conditions may facilitate better range of motion (ROM) and function following ankle replacement.

   Researchers retrospectively reviewed 95 patients who had received total ankle replacements, were assessed via post-op ROM fluoroscopy and had completed a subjective patient score sheet. The study compared data such as ROM, age and body mass index (BMI) with patient satisfaction to determine if any conditions could predict successful outcomes.

   Patients over the age of 60 and those with a BMI of less than 30 showed a “significant positive association” with subjective patient satisfaction scores, according to the study.

   The authors also note that post-op ROM did not correlate with patient satisfaction. The researchers conclude that patient satisfaction was not significantly associated with patients under 60, BMI over 30, additional procedures, perioperative complications, the length of time after surgery and the presenting etiology.

Addressing Patient Expectations

The study notes that although patients often expect more range of motion following ankle replacement, they most frequently appreciate pain relief. The authors suggest that this probably accounts for the rates of patient satisfaction they found in the study.

   Lawrence DiDomenico, DPM, will typically tell his total ankle replacement patients they will only get a little more motion postoperatively than they had prior to the surgery. While some patients do “extremely well” with increased ROM, Dr. DiDomenico notes this scenario is less common. Before surgery, he will educate the patients that the goal is to reduce pain and improve function. Robert Mendicino, DPM, concurs. He notes that while ankle replacements restore pain-free range of motion, they do not necessarily restore normal ROM.

Emphasizing Appropriate Patient Selection

Age and BMI “play a major role” when it comes to proper patient selection for ankle replacement procedures, according to Dr. Mendicino, the Chairman of the Department of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh. He also considers the presence of other medical conditions, bone quality, deformity and ligamentous stability. Dr. Mendicino emphasizes that the indications are not as clear-cut as one may think and he advises considering all parameters when offering ankle replacements as a choice to patients.

   In Dr. DiDomenico’s experience, older patients do better following ankle replacement. He says such patients have fewer physical demands and their interests pertain more to walking and golfing rather than aggressive sports. Patients with higher BMI place more stress on the ankle replacement, adds Dr. DiDomenico, the Section Chief of Podiatry at St. Elizabeth’s Hospital in Youngstown, Ohio.

   To improve ankle implants in the future, Dr. DiDomenico suggests the development of longer-lasting prostheses, perhaps lasting as long as 15 years. He also suggests performing less bone resection, noting that if the ankle replacement fails, it is easier to convert it to an ankle arthrodesis.

   Dr. Mendicino notes continued advances in ankle replacement devices and emphasizes they are not a fad. While total ankle replacements may not achieve the same numbers as hip and knee replacements, Dr. Mendicino says they can have an impact for patients when they are properly indicated.

   “This is now (and in the future) a valuable option to treating debilitating ankle arthritis,” Dr. Mendicino, a Fellow and Past President of the American College of Foot and Ankle Surgeons.

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