Total ankle arthroplasty (ankle replacement) significantly improves quality of life making a return to light recreational activity and non-impact sports possible, according to a recent study published in the October issue of Foot & Ankle International (FAI), the official scientific journal of The American Orthopaedic Foot & Ankle Society (AOFAS).
"The return to sporting activities after total ankle arthroplasty has rarely been evaluated. The goal of this study was to evaluate ankle function and sports participation among patients with total ankle prosthesis," states Mark Casillas, MD, an AOFAS member and co-author of the study.
The study reflects the outcomes of 140 patients who were operated on between 1997 and 2005. All received a single type implant and the procedures were all performed by Dr. Michel P. Bonnin in France. The post-operative study measured three aspects of ankle function: 1) overall perception of the ankle (normal, nearly normal, abnormal), 2) ankle performance during activities of daily life, and 3) ankle performance during sports and recreational activity.
Four and a half years following surgical implant, more than 75% of the patients participating in the study considered their ankles normal or nearly normal with less than 25% considering their ankle abnormal or highly abnormal. Forty-nine percent of the patients presented no discomfort in their daily activity but experienced discomfort in sports and recreation, 31.4% indicated no limitation related to their ankle in any situation and 17% were limited in their daily activities related to their ankle.
Although most often study patients who participated in sports indicated discomfort or slight pain in their ankle, the percentage of patients who indicated that taking part in the following sporting activities was totally painless include:
-- 86% for swimming -- 84% for outdoor cycling -- 62% for gymnastics -- 53% for downhill skiing -- 37% for hiking and cross-country skiing -- 34% for gardening -- 29% for dancing
New generation prostheses have resulted in renewed interest in total ankle arthroplasty. Total ankle arthroplasty has its advantages, disadvantages and the procedure is not without risk. The co-authors note that the decision to choose between arthrodesis (ankle fusion) and total ankle arthroplasty is often difficult to make. Among the many decision making factors between the two options, two are particularly important, the prosthesis lifespan and the functional results after implantation.
The authors further note that having reasonable expectations of the functional outcomes following total ankle arthroplasty is critical to the success of the procedure. While the study shows improvement in ankle function, the authors note that impact sports or strenuous activities are rarely possible after total ankle arthroplasty. Dr. Casillas advises, "Although participation in sporting activity produced no adverse effects in this study, it is likely that impact sports may increase the risk of arthroplasty failure."
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