Now, the other choice that we have is to do an ankle replacement. Ankle replacements are much newer than knee replacements or hip replacements, and we're talking about a much smaller joint with higher pressures going through the area. And so, there've been several generations of these implants, over the past 20 to 30 years, which have come out. And, we're starting to get some mid-range data on outcomes of these procedures, but, we don't have, really, any longterm data. We think that these types of replacements only last around 10 to 15 years in most people. And, the problem with doing an ankle replacement on somebody is that if you have to go in and take it out due to failure, in the future, what ends up happening is you have bone loss between the bones, and you have to do an ankle fusion procedure anyway. But, it's a little bit more difficult, because now you're dealing with a hole in the bone, instead of having two bony surfaces contacting each other.
The indications for going in and doing an ankle replacement are really, pretty slim as well. You need a patient who is relatively healthy. You can't have severe, uncontrolled diabetes. You can't have vascular disease. There's a lot of other issues, which can pretty much tell me, as the surgeon, that I should stay away from doing an ankle replacement, because they're gonna have a high risk of complications. Other things are, if there's any angulation to the bones, it tends to load the ankle joint in a [malpositioned] way, so that the forces going to the ankle are disrupted at one side to the other. And, this causes extra load on the implant and can, ultimately, result in premature failure.
And so, we'll really look at that on the X-rays, and we'll make sure, does this person have a well-aligned ankle to begin with? And, if so, we may consider a total ankle replacement. Having said that, there's other problems with total ankle replacements that the person with an ankle fusion doesn't have. The total ankle replacement patients, even though they can move their ankle, they still have a joint. And so, the pain relief isn't as consistent as it is with doing an ankle fusion or arthrodesis procedure.
