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Orthopaedic Surgery

Newly approved devices make ankle replacement surgery an option for more patients with ankle pain


Total ankle replacement can relieve chronic ankle pain while preserving joint mobility. While an artificial ankle has been available with FDA (Food and Drug Administration) approval since 1992, the recent approvals of four additional ankle replacements expands options for physicians and patients and significantly broadens the population of patients who are likely to benefit from the procedure. These new implants have all been used successfully abroad prior to FDA approval.

The choices have improved dramatically enough that UCLA orthopaedic surgeons feel it is appropriate to resume offering the procedure. After discontinuing the surgery when it failed to benefit enough patients, UCLA orthopaedic surgeons carefully monitored and evaluated the products available for total ankle replacement. The replacement ankles now available offer very good results to many patients with ankle pain.

UCLA orthopaedic surgeons are highly experienced in performing ankle replacements. Success rates for ankle replacement have been reported at up to 92 percent, with success being defined as restoring the ability to perform the activities of daily living without pain in the joint.

Who many benefit from the procedure

Ankle pain is most frequently the result of a fracture, with chronic pain developing either early after the fracture or later, with degeneration of the cartilage. Other common causes of chronic ankle pain that may be treated with ankle replacement include osteoarthritis and rheumatoid arthritis.

While the newly approved devices allow surgeons to perform ankle replacements on patients with a range of ankle deformities, some ankles are too deformed for joint replacement. In addition, due to a lack of evidence about the longevity of ankle replacement, orthopaedic surgeons prefer to delay its use in younger patients. Other contraindications for ankle replacement surgery include evidence of infection in the ankle, poor blood supply to the joint and poor circulation to the legs.

Other surgical treatments are available for patients who are not good candidates for ankle replacement or to delay ankle replacement in younger patients. Orthopaedic surgeons can perform an osteotomy, cutting the bone and realigning the joint. Arthroscopy is used to clean excess material that may be causing pain in the joint. Fusion joins the bones together to eliminate pain, though it also eliminates joint mobility.

Surgery and recovery

The ankle replacement surgery takes approximately two hours. Surgeons do not cement the device in place, relying instead on bone ingrowth to the implant, forming a long-lasting bond. Most patients stay in the hospital overnight, although same-day discharges are possible in some cases.

The patient’s ankle remains in a cast for six weeks after surgery with physical therapy beginning once the cast is removed. The surgery produces almost immediate pain relief, with function restored after 12 to 16 weeks. Ankle replacement patients are seen for routine annual follow-up.

Program physicians

Andrea Cracchiolo, M.D.
Director, Foot and Ankle Division
Professor of Orthopaedic Surgery

Nelson SooHoo, M.D.
Assistant Professor of Orthopaedic Surgery

Patient referral

For more information, or to refer a patient to the Foot and Ankle Division at UCLA, please call (310) 319-1234 or fax (310) 319-1240.

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