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Artificial ankle implants are options for the elderly to improve quality of life
With an ageing society comes worn-out joints, usually in the hip or knee which can be easily rectified with artificial parts as replacement. Now older people suffering from prolonged pain and have restricted movement due to worn-out ankles also have this option.
Singapore General Hospital has been offering the latest techniques in Total Ankle Replacement (TAR) for the past two years.
Senior Consultant and Director of the Foot & Ankle Service Associate Professor Inderjeet Singh Rikhraj says, “This surgery allows us to replace the entire ankle joint with artificial parts. The implants used have been redesigned so that they now mimic the ankle joint in terms of flexing, extending and flipping from side to side, more closely than previous versions.”
Improved design gives better outcome
 SGH is the first hospital in South East Asia to use Mobility Mobile Bearing Total Ankle Replacement System, which was selected after careful assessment of 10 implant designs now in use internationally. Professor Inderjeet (photo) says, “This design is a second generation implant from Europe. The good thing is we don’t need to shave so much bone as before from the patient.”
Since March 2006, 10 patients have had their worn-out ankles replaced with artificial ones made of cobalt chrome alloy and high-grade polyethylene.
“We’ve had male and female patients in their late 50s. All had implants placed in one ankle. Their surgeries were successful. But in the long term, they would need to look after their operated ankle well.”
This means doing prescribed exercises and avoiding heavy loads or not putting on extra weight so as not to stress the implant. Professor Inderjeet adds, “Squatting will be difficult for them as this will stress the implant.”
Patients are carefully screened
Patients who undergo TAR surgery have to be carefully assessed as the implant is designed for ordinary daily activities.
“It is not a suitable option for the young as their demands on the ankle will be greater and the implant may fail. But for the elderly who just want to improve on their quality of life and be free-of-pain, TAR is a viable option.”
The TAR surgical technique was first developed in the 1970s but that came with limitations, as Professor Inderjeet explains. “Early designs used a ball and socket joint and they failed because those versions didn’t understand the biomechanics of the ankle. The latest designs have been improved on and give better outcome.”
Before the advent of the latest TAR, the only surgical option available is ankle fusion. This remains the preferred option Professor Inderjeet recommends for younger patients.
“This procedure involves removing cartilage and inserting screws across the worn-out joint to allow the bones to grow together. The patient can walk pain-free after surgery but will experience a limited motion range.”
Prevention comes with early assessment
Unlike the hip and knee, the ankle is not a common site to be afflicted with arthritis. People with ankle arthritis are likely to experience some instability in their ankles from repeated strains, or have had suffered an injury to the joint.
To cut down the risks of arthritis developing in your ankles, Professor Inderjeet’s advice is to take care of sprains early. “If you have ankle pain, come forward and be assessed. There are 1,001 causes of ankle pain and it does not necessarily mean arthritis. But you should seek treatment because we can offer solutions.” |