Total Ankle Replacements on the Rise, Says Santa Cruz Orthopaedic Institute

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Active adults, new technology driving demand.

New ankle implants and baby boomers who want to stay active are driving the growth of the ankle replacement market.

As baby boomers push into their 60s and 70s, the number of total ankle replacements continues to rise, particularly as new technologies are now making success more likely and repeatable.

An active aging population and improved medical devices are contributing to the rise in ankle replacement procedures, known as ankle arthroplasty, according to Dr. Nicholas Abidi, who founded Santa Cruz Orthopaedic Institute in 2000.

Abidi has seen a 50 percent rise in ankle replacements over the last two years, though he has been doing total ankle replacements since 1996. Nationally, orthopaedic surgeons did about 775,000 hip and knee replacements in 2010, compared to just 4,500 total ankle replacement procedures.

“Ankle replacement technology has definitely improved over the last decade, and surgeons can achieve more reproducible results,” said Abidi, who specializes in lower extremity reconstruction. “This is contributing to increased numbers of active baby boomers opting for replacements to stay active.”

With the stresses placed on the complex ankle joint, early replacements had a high failure rate, he added. This drove many surgeons to abandon ankle arthroplasty and return to ankle fusion, which has been the gold standard to treat severe and chronic ankle pain.

Abidi was one of the first orthopaedic surgeons to re-introduce ankle arthroplasty after arriving in California in 2000.

For patients experiencing severe ankle pain due to injury or arthritis, the total ankle replacement is now taken seriously by surgeons performing reconstructive ankle surgery. In a fusion, the surgeon removes the surfaces of the ankle joint to promote the growing together of the lower leg bones, the tibia and fibula, with the talus, a critical bone in the ankle joint that connects the leg to the foot.

While fusion eliminates the often debilitating pain, patients are left without any mobility and a stiff step that affects most types of activity.

New ankle prostheses have improved designs and include highly precise cutting guides and jigs that help surgeons achieve better alignment and reproducible results. In a total ankle replacement, Abidi uses the anterior approach, an incision in the front of the ankle that provides him the best way to visualize the area and make proper cuts for inserting the implants.

He uses various implants, including Wright Medical as well as Tornier, a cone-shaped replacement joint whose manufacturer says has a better relationship with the human anatomy in recreating normal joint function.

Patients must stay non-weight bearing for six weeks, followed by physical therapy and convalescence that takes about six months.

Of all joint replacement procedures, ankles have the highest failure rate due to the challenge of getting proper alignment of the replacement joint. In addition, ankle replacement parts can fail and loosen. Even with improved implant technology, most orthopaedic surgeons would agree that the choice of device is of less importance than the skill of the surgeon.

Patient selection is also important. Abidi is very particular in vetting patients to ensure they are the best candidates for successful outcomes. That commitment enables him to achieve a 96 percent success rate. That compares with an average national success rate of 85 percent for ankle replacements.

Playing basketball until age 40 caught up with Aptos, Calif. resident Robert Peterson, who was resorting to canes, walkers and splints in his 60s to alleviate the pain from degenerative arthritis. Though advised by Abidi in 2001 that the next option was an ankle replacement, the retired electro-mechanical engineer wasn’t convinced the implant technology was far along enough.

A decade later in spring 2011 he finally had the surgery, and by six months was walking straight, doing Tai Chi, golfing, even dancing.

“I hate to admit it, I probably should have had the surgery years ago,” said Peterson. “I’ve regained so much of what I lost. I guess the only good thing about waiting was the replacement parts really improved.”

More information on joint replacements and other orthopaedic issues is at or by calling (831) 475-4024.


Gail DeLano
DeLano Communications

Gracia Krakauer


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