Total Ankle Replacement With No Metal

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Total Ankle Replacement With No Metal

http://www.sciencedaily.com/releases/2008/06/080624150654.htm

Patients suffering from severe arthritis now have an option for total ankle

replacement that offers increased mobility and pain relief without permanent

metal implants.

Pioneered by K. Lee, D.P.M., F.A.C.F.A.S., at UC San Diego

Medical Center, this technique is the first in the U.S to offer

arthritis sufferers a non-metal, biological ankle replacement.

" Up until now, patients have had two options for replacing their

ankle joints: metal implants or fusion of the joints, " said Lee,

director of foot and ankle surgery at UCSD Medical Center. " Now there

is an option that actually restores the ankle with an FDA-approved

biologic material that is similar to the collagen found in cartilage. "

During a two hour minimally-invasive surgical procedure, Lee, a

podiatric foot and ankle surgeon, removes the damaged cartilage

around the ankle joint through a four centimeter incision. The

collagen material is then molded into the joint where it adapts to

the contour of the patient's ankle.

" Unlike a metal device, the advantage to this material is that the

implant can be customized in size and contour for every patient's

individual need, " said Lee. " No matter how the patient's ankle is

shaped, the collagen is a perfect fit. "

The biologic material, processed from either human or animal collagen

sources, has been used for more than 10 years in plastic and

abdominal surgery and heart valve replacement. Since it is non-

allergenic and sterile in nature, there is no risk of rejection or

need for the patient to take immunosupressors.

To allow the material to integrate fully with the ankle joint, a

temporary external device is used to stabilize the joint area while

keeping it " distracted " or open for a period of 4-6 weeks. Attached

by small pins, the cylinder-shaped device serves as a shock system to

keep the joint free from friction and movement until healing is

complete. The device is then removed entirely, which keeps the

patient's ankle free from any metal parts.

" Within 3 weeks after surgery, we see an incorporation of tissue onto

the damaged cartilage, " said Lee. " The idea here is to avoid fusion

of the ankle and to add longevity to the joint. We want to give

patients as much mobility as possible so they can get back to the

activities they love the most. "

Lee's patient's range in age from 30-85. , 82, a retired

professor, received the ankle replacement after repeated attempts at

physical therapy.

" My ankle collapsed on me, " said . " I didn't like the idea of a

fusion with no motion or opening up my ankle for a metal device.

Following this surgery, I no longer have sharp or stabbing pains. I

am continuing to improve and can get around better. "

For years, patients have had the option of total joint replacement in

the hips, knees, and ankle with titanium and other metal devices.

While the implants are well suited for hips and knees, metal

replacements for the ankle show a high level of failure and unwanted

complications such as metal collapse and breakage. Once an ankle is

replaced with metal, options for revision surgery are little to none.

According to the Centers for Disease Control, an estimated 46 million

U.S. adults, approximately 1 in 5, report doctor-diagnosed arthritis.

As the U.S. population ages, these numbers are likely to increase

sharply. The number of adults with arthritis is projected to increase

to 67 million by 2030, and a good proportion of U.S. adults will have

limited activity as a result. Nearly two-thirds of people with

arthritis are younger than 65.

This novel technique for ankle replacement and results of a study

will be described in late 2008 in the Journal of Foot & Ankle Surgery.