Ankle replacements, a new kid on the block compared with knee and hip replacements, used to be deemed a risky bet for patients under 65.
But as doctors steadily gain confidence that the replacements will last, Carrie Kvitko, 60, from Columbus, Ohio, is one of a growing group of younger patients to sport a new ankle, made of metal and plastic and bending nearly as well as the original. In September, a year after her surgery, Mrs. Kvitko went on vacation to Magic Kingdom Park in Orlando and climbed 116 steps to the top of the Swiss Family Tree House.
“I’m young,” she says. “I want to be able to do things. I don’t want to give that up.”
Nearly 10,000 total-ankle-replacements will take place this year in the U.S., about double the level in 2011, according to estimates from SmartTRAK, an online market-data system from BioMedGPS LLC of Irvine, Calif.
That growth is due in part to mounting evidence over the past several years that a particular device is long-lasting. Most recently, at a scientific meeting in September in Lisbon, Duke University researcher James A. Nunley presented data on Stryker Corp.’s Star ankle. The finding: For a group of patients who took part in a trial before the device hit the U.S. market in 2009, 88% of 58 devices were still in place 10 to 19 years after implantation.
There are limits to how much ankle replacements can replicate healthy ankles. They aren’t meant to take running or jumping, says Lew Schon, an associate professor at Johns Hopkins School of Medicine and co-designer of a replacement ankle from Zimmer Biomet Inc., in Warsaw, Ind. You can run and jump, but the unit will wear out faster. It is possible to ski, though, Dr. Schon says, since skiing has less impact on an ankle than, say, jumping.
Recipients also could need follow-up surgery. A study presented last year at the American Orthopedic Foot & Ankle Society meeting in Toronto found that 25% of 761 patients needed some type of repeat surgery during a 15-year period, such as replacing the plastic parts of the device, which tend to wear out faster than the metal components.
“Getting a total ankle [replacement] is like getting keys to a car,” says Gregory Lundeen, a Reno, Nev., orthopedic surgeon who trains surgeons in implanting the Star. “You have to have it serviced on a regular basis.”
While ankle replacements typically occur later in life, the cause isn’t usually arthritis from simple wear and tear, as it is for hip and knee replacement. Ankle arthritis is usually the result of past trauma, such as a broken ankle, says Gregory C. Berlet, a surgeon in Westerville, Ohio, and design consultant to Dutch medical-device company Wright Medical Group NV, which sells three replacement ankles in the U.S.
By Laura Johannes | The Wall Street Journal
Image Credit: Stryker