Total Ankle Arthroplasty
Original Editor - Jeremy Brady
Lead Editors - Jeremy Brady, Neha Palsule, Jorge Solorzano, Tori Westcott, Dana Williams
Search Strategy[edit | edit source]
Databases Searched: PubMed, CINAHL, Cochrane, JOSPT
Keywords Searched: ankle arthroplasty, ankle physical therapy, ankle replacement, total ankle arthroplasty, total ankle replacement
Search Timeline: June 11th 2011 -
Definition/Description[edit | edit source]
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Epidemiology/Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
Indications:
According to JOSPT, there are no exact indications for receiving a total ankle arthroplasty. The “ideal” patient who would typically undergo this intervention is one who is elderly with a healthy immunity, normal vascular status, good bone density, and a proper hindfoot-ankle alignment. Individuals with debilitating ankle arthritis, unresponsive to nonoperative approaches, or have failures with the outcome of their ankle arthroplasty are typically treated with an arthrodesis procedure to fuse the joint.
Contraindications:
Arthroplasty is contraindicated for those with neuroarthropathic degenerative joint disease, infection, AVN of the talus, malalignment of the hindfoot-ankle, severe benign joint hypermobility syndromes or soft tissue problems, or decreased sensation or motion in the lower extremities.(JOSPT) In individuals with RA, inflammatory processes may occur before signs of swelling, tissue reaction, and joint destruction are seen. In the first and second year of this disease process, structural damage (ie. joint erosion) can be seen with X-ray imaging. (p.530 Goodman,Snyder) Diabetic pts may develop gouty arthritis in their ankle joint. This is caused by uric acid changing into urate crystals, which is deposited into the joint. (p.499)(Goodman, Snyder)
Thus, RA and diabetic individuals may or may not be candidates for ankle arthroplasty depending on the severity of joint degeneration found with radiographic imaging.
Differential Diagnosis[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Notes to Incorporate
- Agility ankle is currently the only ankle prosthesis currently approved by the US FDA (in 2007)[1]
- it is a 2 component design that completely resurfaces distal tibia and talar dome[1]
- also incorporates fusion of the distal tibiofibular syndesmotic articulation. This fusion allows the medial border of the fibula to provide additional support to the prosthesis, while providing additional surface area for biologic fixation[1]
- prosthesis we use for our patients who decide to undergo total ankle arthroplasty[1]
- STAR is the design choice for Europe[1]
Physical Therapy Management
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Guidelines for Rehabilitation Following Total Ankle Arthroplasty | |
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Immobilization | |
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Weight Bearing | |
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Exercises for the Involved Ankle & Foot | |
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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