Daniel Scott, M.D., MBA, and Christopher Gross, M.D., perform ankle replacements together as a team, which results in more positive outcomes and less time in the operating room. In a recent total ankle replacement procedure, the two surgeons removed the damaged joint and replaced it with a prosthetic version to provide improved mobility and decreased pain to their patient. Scott describes the procedure and the importance of MUSC’s unusual team approach.
an ankle replacement is a treatment for ankle arthritis where you have wear and tear of the tibial taylor joints. So the tibia joints sort of on the top tales joint on the bottom. Um And you actually replace the worn out cartilage pieces on both sides with two metal pieces and a little plastic bearing that goes in between same idea as sort of a knee replacement when the joint wears out. This is a way that will replace it and preserve your motion. We have a variety of different implants that we use here. We have sort of some more bone sparing implants sort of like our little sports cars that are really nice for sort of your run of the mill sort of very active patient to kind of get them the most motion possible. And then we also have some you know bigger heavier duty or options for either sort of like the revisions or the patient that has a really really crooked e ankle that needs a lot of work to sort of make them straight and get them back in the right place. Um So revision is still a replacement but it's sort of like a redo um So just like if you had a knee replacement that goes bad then you have to revise it or redo it. So it's a little bit harder when somebody's been in there before there's more scar tissue you have to work a little harder to get kind of things moving. Um And there are certainly some folks who had other foot ankle surgeries before. May have a lot of scar tissue. may have had some other prior procedures that didn't work. Um And those can be sort of more of like a redo situation as well. It's a really good option for patients within stage ankle arthritis. Um and especially patients that are, you know, a little bit older, which is the majority of patients that are maybe not some people that want to go running around hiking mountains, that sort of crazy stuff. Um Anybody with arthritis and their other joints is actually a really good candidate for ankle replacement because it helps reduce the stress on the other joints. So total ankle replacement is complex because often there are other procedures we have to do at the same time and often people have a sort of a crooked ankle. They have deforming the coronal plane or mythological plane. So either their ankles stuck in various or Vegas is too far forward or backwards. And so we've got to work to not only realign the ankle under the correct position, but then also replace the joint. So it makes a little more difficult than some of your run of the mill knee and hip replacements here, we tend to do those surgeries with two surgeons myself and dr gross. The benefit of that is it allows us to move quicker. So we can be more efficient surgery when you've got two surgeons knowing what you're doing. It also allows us to have a higher volume. So we found out with lots of different operations folks tend to do better insurgents have better outcomes if they do more of the surgery. Right? So that's one of the other benefits of having two surgeons is you just, you see more ankle replacements, you get more comfortable with it, you're more comfortable with dealing with the hard ones. Um, and certainly there's a lot of research has shown you have better outcomes of surgery, the more ankle replacements the surgeon's done, it is definitely something that's becoming more common. There are a couple other centers in the country that are very high volume and replacements that is actually do the same thing. Um there I would say are still only a handful of places that do that, but a lot of the highest volume people in the country are people that are taking a team approach because they have really seen the benefits of having to really skilled people in there to be able to get the surgery done as quickly as efficiently as possible. And also in the right way more. Typically, an ankle replacement occurs and change your approach to the ankles. You have incision on the front, you get down through sort of a tendons, move the nerves out of the way and that gets you straight to the front of the ankle. We often use jigs or custom cutting blocks that help guide our cuts so that we've got some idea ahead of time exactly where we want to make those, we use X ray to make sure that those jigs are in the correct position and then we make saw cuts again on the tibia and the patella to take out the bad joint. We remove that bone and then we help prepare that bone using a different bunch of preparation methods to get it ready to receive the prosthesis. And then we implant in the tibial component often first and then we implant in the taylor component and then the last thing we do is put in a little plastic space or the polyethylene that again access sort of a cushion for that joint. Just like again you would work for any replacement. Um Pain relief. Number one, you know these are people with bad ankles and we want to get them feeling a lot better and get them back to drawing activities. They want to do number 21 of the reasons we really like ankle replacements as opposed to ankle fusions, which is one of the other treatment options is that both preserves motion and decreases the stress on adjacent joints. One of the biggest challenges with an ankle replacement is people tend to get adjacent joint arthritis where the other joints wear out with time. We have not seen that with ankle replacements. Um So in addition to preserving motion, we're preserving the other joints and trying to give them the highest level of function possible. So typically anchor replacements patients either go home the same day or spend one night in the hospital and go home. Uh patients are typically, and either a splint or a cast initially and we don't want them to put any weight on the first two weeks. If we don't do any additional surgeries, often they start walking at the two week mark and usually at six weeks we start them in physical therapy. Um If we have to do other competent procedures, lengthen tendons, do some work to change the position of bones. Sometimes we'll keep patients off of it closer to six weeks, but again, sort of the easy, straightforward ankle replacement. We typically let them walk in two weeks. Um you know, I would tell most folks, you know, you can probably back on the golf course and a tennis court somewhere between, you know, 3 to 4 months after surgery is probably the average. This team approach has worked really, really well here and allows us to be high volume to be able to do the same operation over and over again in a reproducible way and have really good outcomes. There's also a place that we are really big on research. So we study our outcomes, we study our patients to make sure it's that highest standard in the country because the goal is to be, you know, the best team in the country doing this. Um and we're already up there in volume of with some of the other highest volume centers in the country, in the Southeast. And this approach really allows us to do that and have the best outcome possible for our patients.
