By Mr Andy Goldberg OBE
Consultant Orthopaedic Surgeon

Arthritis in the ankle is extremely painful and can affect someone’s quality of life as much as end stage heart failure. Even getting up to make a cup of coffee can be difficult.

The commonest cause of ankle arthritis is a break of the ankle or leg or recurrent severe sprains, but it can take anything up to 20 years to develop because the cartilage wears away gradually and with it does the shock absorbing capacity of the joint lining. Eventually bones rub against bones which cause a limp, stiffness and pain.

Physiotherapy and losing weight can help in some cases - otherwise, surgery may have to be considered.

Every year, 29,000 patients in the UK seek help from an orthopaedic surgeon for ankle arthritis. The main treatment to date has been ankle fusion – where the bones are joined together with screws to stop movement. The disadvantage of this is that because the joint can no longer move, stresses happens at other joints around the ankle and foot or even the knee or spine, putting them at risk of wear and tear arthritis.

Ankle Replacement is a newer technology which, just like a hip or a knee replacement, allows movement in the joint to be retained and hopefully less stresses to be placed on the other joints. The joint replacement is made of metal with a plastic lining to allow the bones to glide and move more normally.

In the UK about 900 ankle replacements take place each year and long term outcomes are improving, however nearly 2 per cent of ankle replacement procedures fail each year - the equivalent of 20 per cent after ten years, which is more than double that of hip or knee replacements. The Royal National Orthopaedic Hospital performs more than 50 ankle replacements per year and is one of the leading centres in the UK. There is evidence that centres that carry out a higher volume of these procedures have better patient outcomes.

The Royal National Orthopaedic in Stanmore, England have pioneered a new technology that uses a scan of the patient to 3D print a replica of the patient’s bones and then plan a specific replacement designed for the actual patient.

This new technique is known as patient specific instrumentation.

The Prophecy Infinity ankle replacement technique allows me to see detailed architect drawings of the patient’s anatomy and I can decide exactly how I plan to do the operation and anticipate any surprises well before the day of surgery”

said Mr Andrew Goldberg OBE, consultant orthopaedic foot and ankle surgeon.

I find the technique much more accurate and believe that precise positioning of the prosthesis is crucial to ensure its longevity

With other conventional replacements the surgeon has to rely on cumbersome frames and rods to align the implant correctly and it is in some cases more of an art than a skill” said Mr Goldberg.

Before I began using this approach, my patients would take up to a year to walk pain-free. Now most are pain-free by six weeks and without a limp by three months.

The Royal National Orthopaedic Hospital is involved in a clinical study on ankle replacement surgery see Ankle Arthritis website

For more information please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5712/13

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