Ankle Replacement Surgery and Other Advances: Joint Replacement Moves Beyond Knees and Hips
We hear about knee and hip replacement. But chronic osteoarthritis can prompt the need for ankle replacement surgery or new shoulders, wrists, feet, even knuckles.
For severe osteoarthritis, surgeons are now creating implants for shoulders, ankles, wrists, even knuckles. If your arthritis can’t be resolved with pain meds and therapy, surgery might be in order. Let’s take it from the bottom….
Ankle Replacement Surgery?
- Options to consider: Try other options, of course, before an ankle replacement. In the very early stages of ankle arthritis, the surgeon can go in with a scope and clean out (debride) the joint, removing any bony outgrowths or other debris.
In the later stages of foot and ankle arthritis, bone fusion remains the standard surgical procedure. The goal is to eliminate the motion causing the ankle or foot pain. In fusion, the surgeon removes the cartilage between the offending bones, then uses stainless steel rods, screws, or plates to join them as one.
Total ankle replacement surgery, however, is becoming a good option for certain patients with ankle arthritis.
- Ankle replacement surgery: The ideal patients to receive a total ankle replacement are older, relatively inactive people with debilitating end-stage arthritis who are not diabetic and who do not smoke. One study found that ankle replacement surgery provides greater improvement in physical functioning and quality of life compared to ankle fusion surgery. Unlike ankle fusion, total ankle replacement preserves motion and, in doing so, may better protect joints adjacent to the ankle from arthritic changes that may occur years after ankle.
Shoulder Replacement Surgery?
- In total shoulder replacement, a metal ball attached to a metal stem driven into the humerus (upper arm bone) bears against a plastic cup fitted inside the glenoid socket of the shoulder. In some cases—such as when the ball of the humerus is severely fractured but the socket is normal—the surgeon may perform a partial (hemi) replacement and replace only the ball. Complication rates are similar between the two procedures, one study suggests. Historically, shoulder replacement was mostly an option for older, inactive patients with advanced osteoarthritis and an intact rotator cuff. But surgeons today can offer a wider range of options for osteoarthritis shoulder, depending on the age, disease state, and activity level of each patient.
- Shoulder resurfacing: In shoulder resurfacing, or partial shoulder replacement, instead of removing the entire end of the upper arm bone (humerus) and replacing it with a metallic ball and stem, the natural bone is left in place and the ball is reshaped and fitted with a metallic cap. In addition, the natural indentation in the glenoid cavity, in which the humerus sits to create the shoulder joint, is not replaced with a hard plastic polyethylene cup. Rather, the surgeon creates a cup made from material taken from elsewhere in your body (such as a piece of fibrous tissue from your outer thigh).
- Reverse shoulder replacement: Other advances, such as the reverse shoulder system, are helping older patients retain greater shoulder mobility with less pain. With this system, the normal positioning of the shoulder components is transposed, with the metal ball (glenosphere) and stem fitted into the glenoid cavity and the hard plastic cup on top of a stem fitted into the top of the humerus. This reverse system is designed mainly for patients with severe arthritis who can’t raise their arms due to severe rotator cuff tears. Its design allows the intact and still strong muscles in other parts of the shoulder, such as the deltoid muscle, to take over the work of the damaged rotator cuff and help hold the implant together more tightly than the injured shoulder can. The result is a more stable shoulder that is less likely to dislocate.
Joint Surgery for Arthritic Wrists?
- Wrist fusion: If you’re experience wrist bone pain, this surgery eliminates motion between parts that are often the cause of ongoing discomfort. For active arthritis patients who have only one or two bones rubbing together in the wrist, partial wrist fusion may be appropriate. In this procedure, the surgeon fuses together the problem bones using wires or metal plates and fills intervening spaces with bone graft to help the bones grow together. Newer advances are improving fusion rates by allowing multiple screws to be anchored to each bone. Compared to total wrist fusion, partial fusion can preserve more motion in the wrist.
- Wrist replacement: Joint replacement in the wrist can be an option for some patients with severe arthritis who do not need to use their wrist for heavy daily use. Unlike fusion surgery, wrist replacement may help maintain or recover wrist movement, and it may help improve the ability to perform daily activities.
FYI
UHN editors answer a common question about surgery options for wrist pain:
Q: I have terrible wrist pain due to arthritis and I’m deciding between joint replacement and fusion. How should I make this decision?
A: Rheumatoid arthritis commonly affects the hands and wrists. Medications and nondrug measures, such as physical therapy and joint protection strategies, are the primary treatments. If pain and dysfunction become severe and seriously limit movement, surgery can be considered.
Wrist joint fusion is the more commonly recommended option for wrist rheumatoid arthritis. With joint fusion (also called arthrodesis), bones are permanently joined together, which eliminates pain because the ends of the bones no longer rub together. The procedure involves aligning the bones and using metal pins, plates, screws or rods to hold them together. The bones will eventually grow together. The fused joint no longer moves. It will be possible to rotate the hand, but not to bend the wrist.
Surgeons will consider total wrist replacement (also called arthroplasty) for people who have had wrist fusion on one hand and need surgery on the other. Wrist replacement both relieves pain and allows for continued movement of the wrist. This makes it easier to perform day-to-day activities. But a total wrist replacement is more challenging than the more commonly performed hip and knee replacement surgeries because of the more intricate bone structures and smaller joints in the wrist.
Wrist replacement involves removing some bone and inserting an implant composed of metal parts for each side of the joint. A spacer made of plastic fits between them. After surgery, you will need to wear a cast and then a splint for up to eight weeks. Complete recovery can take months. Wrist implants are more likely than hip or knee implants to loosen and require further surgery.
This was originally published in May 2016. It has since been updated.
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Ankle replacement is becoming more common in cases where arthroscopic cleaning and other options aren't effective.
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