For people who are suffering with severe pain and physical limitations as a result of ankle arthritis, there are a number of medical and surgical options that can relieve pain, stabilize the joint and provide improved mobility.
That’s the good news from a regional expert, David M. Welker, M.D., an orthopaedic surgeon who practices with the Advanced Orthopaedics and Rehabilitation (AOR) group, based in Washington, PA. Welker specializes in problems of the lower extremities and has successfully treated numerous patients over the years for arthritis, fractures and other musculoskeletal problems of the legs, knees and ankles.
One of Dr. Welker’s specialties is ankle surgery. He sees many patients with ankle arthritis, usually due to one of three causes: the normal “wear and tear” degeneration of osteoarthritis; rheumatoid or other autoimmune forms of arthritis; or post-traumatic arthritis that sometimes develops following a fracture. Each type is treated differently, but treatment may include activity modification; steroid injections; brace immobilization; anti-inflammatory medications and the use of assistive devices such as canes to reduce weight bearing and ease pain.
Welker performs both ankle fusions and ankle replacements. “Surgery is always a last resort, when conservative measures are no longer effective to maintain the person’s lifestyle. Ankle fusion and ankle replacement are options, and both procedures produce good outcomes. The decision always has to be tailored to the individual. The patient and I decide together.”
Having an ankle replacement versus ankle fusion depends on several considerations. Primary among them are age and activity level. According to Welker, if you are young, meaning age 40-50, and you lead an active, athletic lifestyle, you would be a candidate for fusion rather than replacement. An ankle fusion relieves pain and restores function, although some flexibility is sacrificed; it also has the benefit of durability, usually lasting a lifetime. An ankle fusion procedure involves removal of the surface cartilage of the joint so that the ankle bones, the tibia and talus, grow together, or fuse. Screws are placed across the joint to hold it together while the bones fuse.
Ankle replacement surgery is not nearly as common as hip or knee replacement, but it is an increasingly popular option for people who have severe ankle pain. Welker says that ankle replacement is probably the better choice if you are older, in the 60-75 age group: “Ankle replacement is best suited for those who live a less active lifestyle. They lower the demand on the new joint and are less likely to wear the joint out.”
Ankle replacement involves removing actual bone, taking off the end of the tibia and the top of the talus and replacing them with prosthetic (artificial) parts. “Ankle replacement is not new but is becoming increasingly accepted,” Welker says. “The procedure had a bad reputation for awhile, back in the 70’s, but that has changed. The quality of the prosthetic ankle joint is much improved, with better design, providing greater durability and longevity.”
Ankle fusion and ankle replacement are actually opposite procedures, Welker explains. “When you do a fusion, you eradicate the ankle joint. In a replacement, you preserve the joint. Both are equally challenging for me as a surgeon. Both involve a fairly long recovery period; you can’t bear weight on the affected foot for six weeks. Physical therapy is provided to strengthen the joint, reverse muscle atrophy and improve gait.”
Welker grew up in Altoona, where he was active in school sports, and attended Juniata College and West Virginia University. He is married to Melissa, who was his junior prom date, and they have identical twin daughters, Hannah and Sarah. Welker knew he wanted to become an orthopaedic surgeon when a high school friend suffered a sports injury that required knee surgery. “I thought it would be cool to be able to help people after an injury like that,” he recalls. He is still an athlete who runs marathons and competes in triathlons.
Welker has always been sympathetic to the pain and immobility that orthopaedic injuries can create for his patients, but in May of this year, he gained firsthand knowledge of this when he suffered a ruptured Achilles tendon while playing basketball. “My injury gave me the patient’s perspective. It gave me new insights and made me more committed to helping people who are living in pain. I’ve always been eager to help those whose lives are limited by pain and loss of mobility, and I want people to know that there is no need to live in misery. You may not need surgery, but we offer other great solutions that that can ease your pain and keep you active.”
AOR’s expert, highly credentialed surgeons perform joint replacement and other elective orthopaedic procedures at Advanced Surgical Hospital (ASH), a dedicated, state-of-the-art hospital that AOR opened in Washington, PA in 2010. The entire facility is dedicated to orthopaedic specialty care and serves as a ‘one-stop shopping’ setting, where patients have access to all the services that they need under one roof. AOR is based in Washington but also has offices in the South Hills, Mon Valley and Greene County.
To learn more about ankle fusion surgery or joint replacement, about AOR or Advanced Surgical Hospital, visit www.advancedorthopaedics.net.