|19 February 2013|
Successes in Latest Total Ankle Replacement Technique
The ankle joint supports walking, running, dancing and jumping motions. When the ankle joint becomes deformed through overuse or degeneration, and causes pain, daily activities will be affected. The latest surgical treatment now available in Hong Kong is Total Ankle Replacement (TAR) surgery. TAR is performed to remove a diseased joint cartilage, and replace it with an artificial joint implant. Patients with TAR treatments will resume a higher degree of mobility within a shorter rehabilitation period of four to six weeks when compared with the traditional fusion method, from which a person may take up to four to six months to recover.
Dr Yeung Yeung, a specialist in Orthopaedics and Traumatology, said, “The ankle joint can wear out over time due to injuries and repetitive use. When the ankle joint cartilage gets worn out to the stage that motion becomes restricted and painful, and the joint becomes deformed, patients can now have the option to replace the diseased joint with TAR.” According to Dr Yeung, worldwide figures showed that four in every 1,000 people over 65 will suffer from some form of ankle degeneration.
Up till now, the gold standard for advanced ankle arthritis is fusion surgery, where the joint is solidly fused together to keep the joint stable and to eliminate the pain when bearing weight (e.g. standing). Nonetheless, the ankle joint will become stiff and motionless after the surgery. Some patients may develop arthritis at the adjacent joint, a condition which generally manifests in about 10 years from the initial surgery.
The principle behind the latest TAR surgery is to remove the diseased joint cartilage and replacing it with an implant made of metal alloy and a polyethylene (PE) spacer. The implant has been designed to mimic the function of a joint, thus enabling a range of motion, and a reasonably functional and mobile ankle joint within four to six weeks after the surgery.
TAR is an accepted surgical option for advanced ankle arthritis in Europe and the US, where the procedure has been performed for over 10 years, and this surgical technique is now being adopted in Hong Kong.
The following types of people with advanced ankle arthritis may benefit from the TAR surgery:
Mr Chang, an airline manager, and an active footballer in his leisure time, experienced pain in his right ankle for more than five years. The ankle subsequently became stiff and he found himself walking with a limp, and had to take pain killers daily. Mr Chang was diagnosed to have advanced ankle arthritis.
Another patient, Mr Collins, a ballet teacher suffered from recurrent ankle sprains. His left ankle deformed progressively and caused him pain when walking, and he could not level his foot with the ground.
Both these two patients underwent TAR surgery by Dr Yeung in June 2012 at Matilda International Hospital, which is the first and only private hospital in Hong Kong to be equipped with the skills and instruments for a TAR procedure. Both patients continued the rehabilitation with a series of post-surgery physiotherapy treatments. They have since resumed their normal activities.
Dr Yeung said that TAR may not be suitable for young and active patients, patients with a history of infections, those suffering from peripheral vascular disease, or from neuromuscular disease with poor muscle control, as well as patients whose daily life or work requires a lot of heavy loading on the joint.
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