By Kendra Bobowick

Maybe friends have had knee replacements, or a parent is walking on a new hip, but do you know anyone with a prosthetic ankle?

Most likely not, according to F. Scott Gray, MD, a Danbury Hospital orthopedic surgeon. Problems affecting hips or knees are less common in ankles, for one, and only as recently as 2006 was a new replacement design approved.

Last November, Dr Gray performed the first ankle replacement in western Connecticut at Danbury Hospital using a Tornier Salto Talaris joint. His thoughts? It’s better than fusion — a frequently employed solution immobilizing portions of an injured ankle. According to a recent release about the surgery, Dr Gray had noted that the ankle is not as prone to arthritis as knees, hips, shoulders, and other joints, but it does occur.

He had said, “Ankle arthritis is about 50 percent less common than knee and hip,” but it does occur after injury, and very often in rheumatoid arthritis, as stated in the release. He referred to fusion as a “gold standard” for ankle arthritis where the joint is removed and the bones are held together with metal implants until the bone fuses

Replacements allow patients to maintain motion, however. While fusion may be “wonderful” to alleviate ankle problems, Dr Gray explained that 15 years or more after surgery, other joints may become worn. “With a replacement, this doesn’t happen,” he said.

The replacement offers not only mobility, but a chance to get back to nonimpact activities, including bicycling or swimming. Sports that involve impact, like running, are out, and “plant and pivot” motions that occur during basketball or tennis, for example, are also off the activities list, said Dr Gray. As he had stated in the release, fusion leaves a joint permanently stiff, which is not good for people such as athletes who rely to the range of motion.

The replacement operations allows people to become “less sedentary, so golf, swim,” he recommended.

He also recommends replacements for men and women 50 years or older. Why not sooner? In Europe the ankle replacements have proven longevity, but their use was only approved in the United States in 2006.

“Until we’re sure” of the replacement’s durability and wear, Dr Gray said he won’t “go younger.”

Currently the options of an ankle replacement is not the first thought a person’s general physician will have when considering what to do with an injured ankle.

“Most physicians don’t have thoughts about ankle replacements — now they should. You have to know it’s available for potential candidates,” Dr Gray said.

Although earlier replacements exist, he noted, “The engineering has been poorly designed and the longevity is poor.” As with any joint replacements, “loosening” could take place years after the surgery. The most recent ankle replacement technology offers “less loosening, and the longevity is better.” Insurance coverage is another hurdle for patients seeking replacements.

“We hope that in five to ten years it will be more reimbursable,” Dr Gray said.