Ankle surgery procedures at Florida Hospital differ depending on the patient’s individual needs. Our ankle replacement procedure provides specialized prosthetic parts to reconstruct the ankle and improve function.
Florida Hospital’s patients have access to some of the world’s top ankle specialists. We are dedicated to providing the most advanced procedures through upgraded technology and breakthrough medical care.
Listen in as Corey Rosenbaum, DO discusses the latest in ankle replacement procedures.
Advances in Total Ankle Replacements
Featured Speaker:
He received his medical degree from Lake Erie College of Osteopathic Medicine and completed his residency at the University of Florida Health Science Center in Jacksonville. He then went to complete his fellowship at the University of Texas in Houston.
His areas of interest include ankle arthroscopic surgery (minimally invasive), fusions, total ankle replacements, reconstructive foot surgery, deformity correction, tendon transfer/foot drop, and treatment of achilles tendonitis/ ruptures, sports related injuries, foot and ankle disorders, flat feet, neuromas and bunions.
Corey Rosenbaum, DO
Corey Rosenbaum, DO is a Fellowship-trained orthopedic surgeon who specializes in the treatment of foot and ankle conditions and injuries.He received his medical degree from Lake Erie College of Osteopathic Medicine and completed his residency at the University of Florida Health Science Center in Jacksonville. He then went to complete his fellowship at the University of Texas in Houston.
His areas of interest include ankle arthroscopic surgery (minimally invasive), fusions, total ankle replacements, reconstructive foot surgery, deformity correction, tendon transfer/foot drop, and treatment of achilles tendonitis/ ruptures, sports related injuries, foot and ankle disorders, flat feet, neuromas and bunions.
Transcription:
Advances in Total Ankle Replacements
Melanie Cole (Host): Total ankle arthroplasty, also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis. My guest today is Dr. Cory Rosenbaum. He’s an orthopedic surgeon with Florida Hospital. Welcome to the show, Dr. Rosenbaum. So, people hear about shoulder replacements and knee replacements and hip arthritis, and all of these things, but we don’t always think so much about the ankle. Tell us about what could typically go wrong with the ankle. What do you see most often?
Dr. Cory Rosenbaum (Guest): The most common thing that I see is actually post-traumatic arthritis. Patients come in and they maybe had an injury, even in their early teens or twenties and then have been dealing with ankle pain or instability, repeated ankle sprains. And then over time, due to that repetitive malfunction of the ankle, they start developing really bad arthritis and, basically, a bad wear and tear of the ankle. They come in to get evaluated now with severe arthritis. That’s what I most commonly see in this area.
Melanie: So, the ankle is a smaller joint when we’re looking at the size of the hip or the knee. What predisposes somebody to this? Is it for athletes? Women who wear high heels? Are there certain things you would like us to know that might contribute to that?
Dr. Rosenbaum: Yes. That’s a good question. In hips and knees, a lot of times that just seems to be a general arthritis, a general wear and tear. The ankle is a little bit more complex and we see it more after some sort of subtle injury or if you have bad rheumatoid arthritis. There’s really no way to prevent it once you have bad arthritis. But, if you have an injury, it’s better to get that treated as early as possible to hopefully prevent some of these longer term complications.
Melanie: We are going to get to some treatments but is there anything you like people to do if they do have arthritis or rheumatoid arthritis to work on their ankle? Are there any sorts of preventions or things they can do to help it along?
Dr. Rosenbaum: Yes. I think the best thing is to try to stay as active as possible. Keep your weight down. The ankle sees anywhere from five to seven times the amount of weight on your body. So, if you just gained ten pounds, the ankle thinks it’s fifty but also if you lose ten pounds, the ankle thinks you lost fifty pounds. So, keeping that stress off your ankle joint, staying active, keeping the ankle mobile by doing a lot of stretching on your Achilles tendon seems to prevent further pain.
Melanie: Are there minimally invasive things we can do first if we do have arthritis in the ankle? When we think of arthroscopy with the knee or the hip, people say, “Oh, I did it and it’s no big deal.” What about the ankle? It is such a complicated smaller joint.
Dr. Rosenbaum: Yes. That’s a good point. Now our technology and instruments are a lot better than they were even ten, twenty years ago. So, if you don’t have bad arthritis where it’s already so severe, or just have a minor injury, doing something like ankle arthroscopy through a minimally invasive small incision that allows us to go in there with a camera and some tools to fix some smaller cartilage injuries or issues with instability, really help prevent long term arthritis and the recovery is a lot quicker.
Melanie: So then, when does it require a replacement? Explain about what an ankle replacement even is.
Dr. Rosenbaum: An ankle replacement is very similar to what you hear with hips and knees where there are two metal components and a plastic piece in between. So, it’s really just the same thing except now we do it in the ankle. The ankle is a more complex joint because it has a lot more areas of motion with rotation, flexion, extension, inversion, eversion. When you get severe pain and deformity, that’s when that procedure could potentially be very helpful.
Melanie: So, what is it like for the patient?
Dr. Rosenbaum: If we determine that the patient has severe arthritis where they failed all conservative treatments and some of the minor procedures can’t be done, that’s when they’d be a candidate for a total ankle replacement. What’s good about the ankle replacement is it really keeps a lot of the motion in tact in the joint as opposed the old standard procedure which was an ankle fusion. That sort of locks the joint in place. With the ankle replacement, again, you keep that mobility and the biggest thing we are finding out is by keeping the normal kinematics and motion of the foot and ankle complex, you prevent arthritis in the other joints. If you fuse the main ankle joint, the other joints that surround the ankle, that are smaller, suddenly have to pick up the slack to try to keep you moving. So, their normal motion which is pretty small in what they can do, now gets very excessive. So, those joints start to wear out really quick and now you have bad arthritis in multiple joints around the fused ankle, and then, you’re still left with chronic pain, limp, and disability.
Melanie: But, because this maintains that range of motion, it helps contribute to an even distribution after the surgery, yes?
Dr. Rosenbaum: Correct. You’re basically trying to keep the same normal motion of the ankle or at least have some of it. Now, if you have bad arthritis you probably already experience a lot stiffness. So, you’re never going to get back to 100% motion of a normal ankle without pain. Just keeping a little bit of motion, whether it is a 20-30 degree arc of motion, that’ll keep you walking with a nice smooth gait without a severe limp.
Melanie: How long is recovery, Dr. Rosenbaum? Is that something that takes a lot of physical therapy or can you get walking and doing rotation exercises pretty quickly?
Dr. Rosenbaum: So, one of the things I really love about the total ankle replacement is the recovery. With the fusion, it’s really hard on patients, especially as we get older, and it’s weaker and it’s harder for us to use assist devices like crutches or walkers. With a fusion, you really have to be off your foot for a minimum of 10-12 weeks of really not putting weight on a leg. Again, a thing I like so much about ankle replacement is that the recovery is actually quicker. Patients get back quicker because they’re really only not putting weight on the ankle for the most part for anywhere from just two to four weeks being off of it and then we have them walking in a boot. So, that part is really exciting and changing the way our post-operative course goes for a lot of these extensive ankle procedures.
Melanie: Is arthritis likely to develop again even though it’s a new joint? What about the surrounding area?
Dr. Rosenbaum: No. That’s the biggest thing is that it’s really preventing severe arthritis in the other joints. Obviously, if we have now replaced your ankle joint, you’re not going to get arthritis because you basically have an artificial joint there.
Melanie: That’s amazing. Now, give us your best advice, Dr. Rosenbaum, in just the last few minutes, about keeping a healthy ankle and what you want people to know about shoes and activity, and prevention.
Dr. Rosenbaum: So, again, the biggest things I think are staying active, keeping your weight down to help prevent any sort of foot and ankle issues. Keeping that Achilles tendon nicely stretched out. You don’t want to get a lot of stiffness there because then you’re going to put a lot of pressure on your mid-foot and other areas of your foot and ankle that will start to cause pain and then it’s just like a bad revolving cycle. It’s hard to get back to good mobility. So, doing just those little preventive things are good. Also, if you have an injury or start to develop even a little bit of pain, swelling, locking, or clicking, that is bothersome, I would get it evaluated sooner rather than later because if you do have just a minor issue--something that we can treat--that would be more preventative than you developing severe arthritis later down the line where then you may need one of these bigger procedures, which although are good and helpful. They’re bigger surgeries that do have more risk.
Melanie: Why should patients go to Florida Hospital for their care?
Dr. Rosenbaum: Well, I think the biggest reason to come here now for the care, especially if you’re a good candidate for the ankle replacement, is that we actually do these here. Before I got here, this procedure wasn’t done anywhere in this area. The closest place to us here was—you’d have to go up to Jacksonville at Mayo Clinic. There’s a physician there that’s doing them that I actually trained under. Also, Orlando, or even farther south, in Tampa. Now, we have the ability to do this procedure here. We have a good team and we have physical therapists in the area that are now familiar with this procedure and that help us once you do start physical therapy, which really isn’t for a least six weeks anyways and it’s not that much. But now, you can get all your care here without having to drive a minimum of two hours just for surgery and follow up appointments.
Melanie: Thank you so much doctor. What a fascinating topic. You’re listening to health chats by Florida Hospital. For more information, you can go to FHFOrtho.com. That’s FHFOrtho.com. This is Melanie Cole. Thanks so much for listening!
Advances in Total Ankle Replacements
Melanie Cole (Host): Total ankle arthroplasty, also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis. My guest today is Dr. Cory Rosenbaum. He’s an orthopedic surgeon with Florida Hospital. Welcome to the show, Dr. Rosenbaum. So, people hear about shoulder replacements and knee replacements and hip arthritis, and all of these things, but we don’t always think so much about the ankle. Tell us about what could typically go wrong with the ankle. What do you see most often?
Dr. Cory Rosenbaum (Guest): The most common thing that I see is actually post-traumatic arthritis. Patients come in and they maybe had an injury, even in their early teens or twenties and then have been dealing with ankle pain or instability, repeated ankle sprains. And then over time, due to that repetitive malfunction of the ankle, they start developing really bad arthritis and, basically, a bad wear and tear of the ankle. They come in to get evaluated now with severe arthritis. That’s what I most commonly see in this area.
Melanie: So, the ankle is a smaller joint when we’re looking at the size of the hip or the knee. What predisposes somebody to this? Is it for athletes? Women who wear high heels? Are there certain things you would like us to know that might contribute to that?
Dr. Rosenbaum: Yes. That’s a good question. In hips and knees, a lot of times that just seems to be a general arthritis, a general wear and tear. The ankle is a little bit more complex and we see it more after some sort of subtle injury or if you have bad rheumatoid arthritis. There’s really no way to prevent it once you have bad arthritis. But, if you have an injury, it’s better to get that treated as early as possible to hopefully prevent some of these longer term complications.
Melanie: We are going to get to some treatments but is there anything you like people to do if they do have arthritis or rheumatoid arthritis to work on their ankle? Are there any sorts of preventions or things they can do to help it along?
Dr. Rosenbaum: Yes. I think the best thing is to try to stay as active as possible. Keep your weight down. The ankle sees anywhere from five to seven times the amount of weight on your body. So, if you just gained ten pounds, the ankle thinks it’s fifty but also if you lose ten pounds, the ankle thinks you lost fifty pounds. So, keeping that stress off your ankle joint, staying active, keeping the ankle mobile by doing a lot of stretching on your Achilles tendon seems to prevent further pain.
Melanie: Are there minimally invasive things we can do first if we do have arthritis in the ankle? When we think of arthroscopy with the knee or the hip, people say, “Oh, I did it and it’s no big deal.” What about the ankle? It is such a complicated smaller joint.
Dr. Rosenbaum: Yes. That’s a good point. Now our technology and instruments are a lot better than they were even ten, twenty years ago. So, if you don’t have bad arthritis where it’s already so severe, or just have a minor injury, doing something like ankle arthroscopy through a minimally invasive small incision that allows us to go in there with a camera and some tools to fix some smaller cartilage injuries or issues with instability, really help prevent long term arthritis and the recovery is a lot quicker.
Melanie: So then, when does it require a replacement? Explain about what an ankle replacement even is.
Dr. Rosenbaum: An ankle replacement is very similar to what you hear with hips and knees where there are two metal components and a plastic piece in between. So, it’s really just the same thing except now we do it in the ankle. The ankle is a more complex joint because it has a lot more areas of motion with rotation, flexion, extension, inversion, eversion. When you get severe pain and deformity, that’s when that procedure could potentially be very helpful.
Melanie: So, what is it like for the patient?
Dr. Rosenbaum: If we determine that the patient has severe arthritis where they failed all conservative treatments and some of the minor procedures can’t be done, that’s when they’d be a candidate for a total ankle replacement. What’s good about the ankle replacement is it really keeps a lot of the motion in tact in the joint as opposed the old standard procedure which was an ankle fusion. That sort of locks the joint in place. With the ankle replacement, again, you keep that mobility and the biggest thing we are finding out is by keeping the normal kinematics and motion of the foot and ankle complex, you prevent arthritis in the other joints. If you fuse the main ankle joint, the other joints that surround the ankle, that are smaller, suddenly have to pick up the slack to try to keep you moving. So, their normal motion which is pretty small in what they can do, now gets very excessive. So, those joints start to wear out really quick and now you have bad arthritis in multiple joints around the fused ankle, and then, you’re still left with chronic pain, limp, and disability.
Melanie: But, because this maintains that range of motion, it helps contribute to an even distribution after the surgery, yes?
Dr. Rosenbaum: Correct. You’re basically trying to keep the same normal motion of the ankle or at least have some of it. Now, if you have bad arthritis you probably already experience a lot stiffness. So, you’re never going to get back to 100% motion of a normal ankle without pain. Just keeping a little bit of motion, whether it is a 20-30 degree arc of motion, that’ll keep you walking with a nice smooth gait without a severe limp.
Melanie: How long is recovery, Dr. Rosenbaum? Is that something that takes a lot of physical therapy or can you get walking and doing rotation exercises pretty quickly?
Dr. Rosenbaum: So, one of the things I really love about the total ankle replacement is the recovery. With the fusion, it’s really hard on patients, especially as we get older, and it’s weaker and it’s harder for us to use assist devices like crutches or walkers. With a fusion, you really have to be off your foot for a minimum of 10-12 weeks of really not putting weight on a leg. Again, a thing I like so much about ankle replacement is that the recovery is actually quicker. Patients get back quicker because they’re really only not putting weight on the ankle for the most part for anywhere from just two to four weeks being off of it and then we have them walking in a boot. So, that part is really exciting and changing the way our post-operative course goes for a lot of these extensive ankle procedures.
Melanie: Is arthritis likely to develop again even though it’s a new joint? What about the surrounding area?
Dr. Rosenbaum: No. That’s the biggest thing is that it’s really preventing severe arthritis in the other joints. Obviously, if we have now replaced your ankle joint, you’re not going to get arthritis because you basically have an artificial joint there.
Melanie: That’s amazing. Now, give us your best advice, Dr. Rosenbaum, in just the last few minutes, about keeping a healthy ankle and what you want people to know about shoes and activity, and prevention.
Dr. Rosenbaum: So, again, the biggest things I think are staying active, keeping your weight down to help prevent any sort of foot and ankle issues. Keeping that Achilles tendon nicely stretched out. You don’t want to get a lot of stiffness there because then you’re going to put a lot of pressure on your mid-foot and other areas of your foot and ankle that will start to cause pain and then it’s just like a bad revolving cycle. It’s hard to get back to good mobility. So, doing just those little preventive things are good. Also, if you have an injury or start to develop even a little bit of pain, swelling, locking, or clicking, that is bothersome, I would get it evaluated sooner rather than later because if you do have just a minor issue--something that we can treat--that would be more preventative than you developing severe arthritis later down the line where then you may need one of these bigger procedures, which although are good and helpful. They’re bigger surgeries that do have more risk.
Melanie: Why should patients go to Florida Hospital for their care?
Dr. Rosenbaum: Well, I think the biggest reason to come here now for the care, especially if you’re a good candidate for the ankle replacement, is that we actually do these here. Before I got here, this procedure wasn’t done anywhere in this area. The closest place to us here was—you’d have to go up to Jacksonville at Mayo Clinic. There’s a physician there that’s doing them that I actually trained under. Also, Orlando, or even farther south, in Tampa. Now, we have the ability to do this procedure here. We have a good team and we have physical therapists in the area that are now familiar with this procedure and that help us once you do start physical therapy, which really isn’t for a least six weeks anyways and it’s not that much. But now, you can get all your care here without having to drive a minimum of two hours just for surgery and follow up appointments.
Melanie: Thank you so much doctor. What a fascinating topic. You’re listening to health chats by Florida Hospital. For more information, you can go to FHFOrtho.com. That’s FHFOrtho.com. This is Melanie Cole. Thanks so much for listening!