Unlike hip and knee surgery traditionally performed on seniors, the majority of TAA patients are younger.
“I’ve had patients with RA who have been in their late 30s and undergone ankle replacement,” Dr. Rush says. “Most patients who undergo TAA are in their 40s and older.”
Contraindications
Dr. Rush says patients with poor circulation (peripheral artery disease) or loss of sensation (neuropathy), or those who have a significant deformity related to a birth defect or previous traumatic event, are not good candidates for ankle replacement surgery.
In addition, elderly or sedentary patients, those who are overweight or those who have comorbidities are considered better candidates for ankle fusion.
Helping Patients Regain Their Quality of Life
Mary Davis, 67, of Salem, Ore., says her ankle woes started when she was a high school basketball player. Ten years later, Ms. Davis tore the ligaments in her ankle and underwent surgery to repair the damage.
Over the years, Ms. Davis’ ankle continued to deteriorate. Although she taped it each morning, over time her ankle became swollen and painful, and it limited her ability to participate in the wide range of sports that she enjoyed.
In summer 2013, Ms. Davis made an appointment to see Kelly McCormick, MD, an orthopedic surgeon with Hope Orthopedics in Salem, Ore.
“After an evaluation, Dr. McCormick said I was a good candidate for either fusion or ankle replacement surgery,” Ms. Davis says. “He explained TAA devices have gotten better than ever, and that implants are expected to last longer than 10 years.”
Ms. Davis first considered ankle fusion, but after Dr. McCormick suggested she try wearing a walking boot that would simulate how her ankle would feel after surgery, she opted to undergo TAA instead.
“With ankle fusion, I found that I [would lose] range of motion,” Ms. Davis says. “I wanted to walk with a normal gait, to play with my grandchildren and to participate in sports and other activities that I couldn’t do comfortably with a fusion.”
In October 2013, Ms. Davis underwent TAA surgery, performed by Dr. McCormick, in a procedure that took approximately two hours.
After making an incision on the side of the ankle, Dr. McCormick removed the arthritic bone and cartilage from Ms. Davis’ tibia and talus. Dr. McCormick then inserted the implant, consisting of two metal components and a plastic spacer, to form a new ankle joint.
“I think TAA is one of the most satisfying surgical procedures,” Dr. McCormick says. “When patients first come to me, they are in so much pain and are so limited in what they are able to accomplish on a daily basis. It’s liberating to see these same patients resume an active, pain-free life after surgery.”
