Scott Webb: Though total ankle replacements are not as common as hip and knee replacements, advances in technology and rising patient satisfaction are helping to close the gap. And I'm joined today by Dr. Craig Radnay. He's a board certified in fellowship trained orthopedic surgeon, specializing in sports and reconstructive foot and ankle surgery, and he is here today to discuss the causes, symptoms and treatment options for ankle arthritis. Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content, and a valuable learning tool for world-class healthcare. I'm Scott Webb. Doctor thanks so much for your time today. We're gonna talk about total ankle replacement and painful ankle arthritis and everything in between. So as we get rolling here, which patients are more likely to suffer from ankle arthritis.

Dr. Craig Radnay: So as it's known by us in the field, arthritis has really become an epidemic in this country. Really By 2040, as many as 80 million Americans, which is about 25% of the population, will have osteoarthritis, which is a phenomenal, an outstanding number to consider. In general though, an arthritis patients really differ from patients who have arthritis of the hip and knee and shoulder. It tends to be more diseases, a young, so the mean age of treatment is typically more around 55 compared to 67, 68 in hip and knee population. So patients in general are seven to 11 years younger than patients with end stage hip or knee arthritis.

And the cause of the arthritis is also different in the sense that an ankle arthritis 80% of the time is really a post-traumatic cause, whereas hip and knee and shoulders really from just wear and tear over time. And so because of that, patients now are much more active than a younger age, much more active than older age. And it can be sometimes just a simple injury and ankle sprain, the down the road can lead to arthritis. And so a lot of these patients have significant deformity and malalignment, which requires a much more complex achievement options.

Scott Webb: Interesting to know, really, that ankle arthritis is often sort of a post trauma things. So all those sprained ankles when we're kids, maybe that bill comes due later. So what are the most common symptoms and limitations of ankle arthritis?

Dr. Craig Radnay: So I think that the symptoms are similar in the ankle as they are in the other joints in terms of pain, swelling, stiffness. You can find that it becomes increasingly difficult to walk, do stairs, to climb, especially going uneven ground. I think that most patients typically find that all of a sudden now they start thinking twice about doing things that otherwise would like to do because of their ankle. And again, the anatomy always plays a key in understanding this is that the ankle is only one third of the surface area of the knee, but it carries about twice the load of the knee.

So it's a significantly painful. So patients that have ankle arthritis really can get very severely physically disabled because of that pain and stiffness. And it's been noted that penis dysfunction of an arthritis is sometimes similar to that of having coronary artery disease or neck arthritis and radiculopathy. So it can be very limiting.

Scott Webb: Yeah. And unfortunately, those of us who get to be a certain age, there are things that we stop doing or we avoid doing. You see a bunch of stairs and you think, Hmm, maybe there's an elevator in this building. So it definitely gets to us and wears us down and makes us think. So what are the non-operative and operative treatment options for ankle arthritis?

Dr. Craig Radnay: So fortunately we do have a variety of options, so certainly in the beginning you can consider anti-inflammatory medications that you just take in pill format. You can consider bracing, physical therapy. Eventually, if the pain continues and the limitations continue their injections you can consider. Cortisone. There's gel injection. There's a lot of new insight into biologic injections as well, where you're taking the body's of blood in your own blood and growth factors and inject that such as platelet rich plasma or stem cells. And eventually if nothing helps, then there's always surgical options.

So sometimes if there's some impingement that's limiting the motion and causing pain, there can be a relatively simple debridement type of surgery. Eventually when patients have end stage ankle arthritis, that's severely limiting. The major surgical options are really a fusion, an ankle fusion where we essentially clean out the worn out ankle joint and then fuse the bones together. And that's surgical option, which was really the gold standard for many years could help in terms of relieving pain, but it certainly would limit the range of motion and change how you walk nowadays, even though the procedure's been around since the seventies.

There are much better results with total ankle replacement, which can help take care of the pain and keep the range of motion, and that basically replaces your arthritic ankle joint with a metal and plastic prosthesis. And the recovery period after that surgery is shorter than having a fusion and people maintain and keep a wider range of motion and most return to active lifestyles.

Scott Webb: And I think most of us are probably maybe more familiar, this is entirely anecdotal doctor, but it feels like hip and knee replacements are very common and everybody seems to know somebody who's had one or the other or both. It doesn't seem like ankle replacement surgery, you know, total ankle replacement is as common. And so I guess I'm wondering what are the outcomes? I know you said what the gold standard was for years. How are things now?

Dr. Craig Radnay: Well, it's a great point that you make because even nowaday, I have colleagues that are so surprised to learn that, wow, you can really do this for hand arthritis. I had no idea. So it is true. And of course in this country, total hips, total needs are very common. That being said, I mean, the ankle replacement market is growing over 10% a year. So I think people are acknowledging that they're becoming more and more disabled from pain and arthritis. At the same time, they're starting to learn that there are options and if they realize they don't just have to live with it.

So I'm sure we're gonna see people dealing this more and more, but currently right now we, we do have some good outcomes that's getting better. We're certainly. Developing newer technologies and treatment options. The implants that we're using these days is really the fourth generation. So as I said, this really started in 1970s, but we've come a very, very long way. So there's better technology, there's better bearings, there's better designs. So all of these are improving stability and long-term fixation and in growth in trying to minimize the wear. And there are multiple studies out there that support as well.

So we're seeing significantly. Improvement of functional outcomes compared to fusion. We're seeing the survivals of these implants really up to 98%, out to four or five years, where there are many studies out there going on now as well to see how well these newest generations of implants are gonna do, because in the end, that's really the gold standard. Fortunately, that in the hip and the knee, in the shoulder world, implants do very well over a longer period of time, and we're hoping that this newest generation of ankle implants will have similar longevity.

Scott Webb: Yeah. That's awesome. It just occurred to me, listening to you, I was like, are we talking about people's angles? Like the human body? Are we talking about designing a new car or something? You know, it's just the technology has come so far from fusion to where we are today. And I think as we wrap up here, doctor, just an opportunity for you to talk about any new advances that we haven't talked about already. Things that you're excited about. And how you'd like to maybe encourage folks that they don't need to suffer, whether they're suffering in silence or not, that they don't need to suffer from the ankle arthritis, whether it's osteo or post-traumatic, whatever it might be. But that there's help out there.

Dr. Craig Radnay: Yeah, I mean, I think that's important. It is exciting. It's always exciting when we have new treatment options and new ways we can help people. And I would say that the important message is really that you don't have to suffer that. What you're dealing with, it can be significant and there are ways that you can be helped. Certainly wanna see a specialist that could provide you the different options. But once you've gotten to the point where you're at an end stage treatment option, I think we do have good surgical options today and going forward, there's certainly new technologies, new designs, new materials that we can use to again, improve the outcomes.

There's also a lot of work now with what we call patient specific instrumentation. So we can essentially try and build an ankle replacement for your own ankle. And that helps us a lot, not just in terms of creating the implant that fits your ankle, but also that can decrease our need for surgical time, decrease the need for x-rays. It really decreased the costs. At the same time, it will improve our accuracy, improve our balancing , it also allows us to really treat much more difficult deformities.

So that's really exciting. We have a lot of new 3D viewers and imaging that really allows us to take each person's ankle individually, look at the deformity, and then find something that can really address their needs the best. So lastly, I just wanna say thank you for the opportunity to speak about this. This really affects many people, but also at the same time, I found that some of these patients are some of my happiest patients, and I'm really happy to help them.

Scott Webb: It's really exciting and really cool. Thank you so much for your time today. You stay well.

Dr. Craig Radnay: Thanks a lot. Have a good day.

Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa General Hospital, please visit cme.tgh.org.