Ankle Joint Replacement


 

Ankle joint replacement also known as total ankle arthroplasty, is a surgical procedure that is performed to treat end-stage ankle arthritis.  Arthritic changes are usually caused by a previous injury to the ankle or leg such as a fracture or ligament tears.  Arthritic changes may also be a result of normal wear and tear due to aging.  This arthritis can eventually lead to loss to cartilage and pain within the joint.

With a total ankle replacement, the motion within the ankle joint is preserved.  By maintaining motion in the ankle, we are able to reduce stress on the knee and joints of the foot which may decrease the chances of developing arthritis in them.  In the United States, there are 10 FDA approved ankle replacements and with the new implant designs we are finding better success than older designs.

Ankle joint replacement surgery is a very complex procedure and should only be performed by a foot and ankle surgeon with extensive experience in replacements.  This is something that is important to ask your surgeon.  There are many studies that have been published in peer reviewed journals that show those surgeons who have more experience with total ankle replacements have better outcomes and less complications.  Dr. Cottom has implanted almost 400 total ankle replacements to date and routinely is traveling around the country training other surgeons on implanting ankles.  In addition, Dr. Cottom has had his research and outcomes published in peer reviewed journals and has written book chapters on total ankle replacements. 


Florida Orthopedic Foot & Ankle Center Total Ankle Replacement Program

Florida Orthopedic Foot & Ankle Center and Dr. Cottom have developed a multidisciplinary team focused on providing the best care for patients with ankle arthritis.  This includes Dr Cottom who is one of the nation’s top trained foot & ankle surgeons and has extensive experience in treating ankle arthritis.  In addition, he is double board certified and completed his fellowship training at the prestigious Orthopedic Foot & Ankle Center in Columbus, OH under the direction of Greg Berlet MD, Tom Lee MD, Terry Philbin DO and Christopher Hyer DPM. 

This program is a “Center of Excellence” using both established and new techniques with a focus on a team approach.  Dr. Cottom utilizes primary care physicians, vascular specialists, nurses, and physical therapists who all contribute to providing the best possible care for his patients.  This team helps educate, prepare and assist the patient through all aspects of the procedure.  At the hospital, patients are offered the opportunity to attend a pre-surgery total ankle education class taught by program nurses and coordinators.  In addition, patients can speak with physical therapists and the staff at the hospital that will help them after the operation and recover comfortably.


Dr. Cottom & FLOFAC Total Ankle Research

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Dr. Cottom has collected data on almost 400 total ankle replacements to date that he has performed.  With this data we are better able to understand outcomes and provide our patients with the best possible treatment when undergoing total ankle replacement.  This is one of the largest data banks in the United States from a single site.

Cottom JM, Douthett SM, Mcconnell KK, Plemmons BS. The Relationship Between Polyethylene Insert Size and Complications in Total Ankle Replacement (Accepted FAS 6-2018).

Cottom JM, McConnell KK, Douthett SM.  Offloading of Total Ankle Replacement Incisions: A Unique Dressing Technique (Submitted FAS 6-2018).

Cottom JM, McConnell KK, Douthett SM.  Offloading of Total Ankle Replacement Incisions: A Unique Dressing Technique and outcomes in 60 total ankle replacements. (Submitted FAS 6-2018).

Cottom JM, Plemmons BS, Douthett SM.  Relationship Between BMI and Complications in Total Ankle Arthroplasty: A Single Surgeons Experience (Accepted JFAS 6-2018).

Cottom JM, Douthett SM, Plemmons BS.  Age Related Outcomes in Total Ankle Arthroplasty (Submitted JFAS 6-2018).

Cottom JM, Douthett SM, Plemmons BS.  A Critical Radiographic Analysis of Coronal Plane Deformity Correction Using a Three Piece Mobile Bearing Ankle Joint Replacement: A prospective Study of 25 patients.  (Accepted JFAS 6-2018).

Cottom JM, Smith BW.  STAR Technique. Primary and Revision Total Ankle Replacement Evidence-Based Surgical Management.  115-130. Springer 2016.

Cottom JM, Et al..  Prospective clinical outcomes of the Cacence Total Ankle Replacement in 130 Patients.  (Current Clinical Trial in Progress)

Cottom JM.  Clinical outcomes of the Hintermann (H2) Total Ankle Replacement: A Single Surgeons Experience.  (In Progress)

 

Hintermann (H2) Total Ankle Replacement

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Dr. James Cottom Implants the First Hintermann Series H2® Total Ankle Replacement System in the United States

May 22, 2018 (Sarasota, FL) - Foot and ankle surgeon, Dr. James Cottom, opened the Florida Orthopedic Foot & Ankle Center so he could offer his patients new, innovative surgical and non-surgical techniques for ankle disease. Cottom, a pioneer in the evolution of total ankle replacement surgery, has been involved in the extensive research and use of various ankle replacement designs for more than 10 years. His ultimate goal being to improve patients’ quality of life by reducing or eliminating ankle pain and significantly improving their mobility.

For the past few years, Dr. Cottom had been following the development of the Hintermann Series H2® Total Ankle Replacement System, designed by world-renowned foot and ankle surgeon, Prof. Beat Hintermann of Liestal, Switzerland. With the FDA clearance of the Hintermann Series H2® ankle in November, 2017 and with 40 successful implantations of the H2 in Europe, it was time to implant this exciting, new ankle in the United States.

Dr. Cottom was honored to be the first surgeon in the United States to implant the first two Hintermann Series H2® Total Ankle Replacement Systems. In May, 2018, with Prof. Hintermann in attendance, Dr. Cottom successfully performed the surgeries at the Lakewood Ranch Medical Center near Sarasota, Florida.

“I am very pleased to be able to offer my patients a lower-profile, total ankle replacement option that conserves bone and is supported by the same technology that has made its sister product, the Hintermann Series H3™, the most successful total ankle replacement system in Europe for the past 18 years.

  “I feel the Hintermann Series H2® is a game changer in ankle arthroplasty, and I am fortunate to have been trained personally by one of the world’s best surgeons, Prof. Beat Hintermann, along with the DT MedSurg team. I am extremely excited to be able to offer this new technology for my patients in Florida, and am looking forward to many successful outcomes.”

 

Two different patients with the Hintermann 2 (H2) Total Ankle Implant in place.

Lateral view of the Hintermann 2 (H2) Total Ankle Implant.  Note the minimum bone resection with this implant.

Dr. Cottom and Dr. Beat Hintermann MD at Lakewood Ranch Medical Center in May 2018.  Dr. Hintermann developed the Hintermann (H2) total ankle implant.  Dr. Cottom was honored to have him present as the first two Hintermann (H2) implants in the United States were performed.

 

Cadence™ Total Ankle Replacement

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A 67 year-old male with longstanding ankle pain and arthritis.  Just walking was painful for him.  Note the narrowing and lack of joint space in the ankle.

After Cadence total ankle replacement the patient is pain free and back to activities.  He especially enjoys walks on the beach without pain and hiking.

A 63 year-old male with pain in his ankle after multiple ankle sprains.  He is a former professional basketball referee.  He is having pain with just walking through his home.

After Cadence total ankle replacement and a subtalar fusion.  He is over a year out from his surgery and pain free.  He is refereeing high-school basketball games without pain or discomfort.

A 75 year-old female with a previous leg fracture who developed post-traumatic ankle arthritis.  She was unable to enjoy short walks with her husband and puppy.

After Cadence total ankle repalcement she is able to walk her puppy and enjoy being pain free.  She is walking over 4 miles a day without discomfort.

 

STAR Total Ankle Replacement

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A 61 year old male with well controlled diabetes and end stage ankle arthritis.  He was having increasing pain in his ankle.  He was told fusion of his ankle was the only option.  He also has a knee replacement on the same side and was concerned about fusion of the ankle and the knee implant.

Fluro images of the STAR implant at the time of surgery.  It is in excellent positon.

Almost 8 years after the implant was inserted.  The patient is pain free and very satisfied he had the joint replaced.  Note the positon of the implant has not changed compared with the images taken during the surgery!  This confirms that the implant alignment and all soft tissues are well balanced around the joint leading to the favorable outcome.

A 78 year old male with a large valgus deformity of the ankle joint and end-stage arthritis.

Both osseous and soft tissue balancing is extremely important in these type of deformities.  This patient had his heel bone moved in a medial direction along with soft tissue balancing to align the implant in proper position.

The joint has been replaced with a STAR Total Ankle.  The alignment of the ankle is excellent.

A 62 year-old male with long standing ankle arthritis.  In addition, on the lateral view his talus is slightly anteriorly subluxed.  He was told by another surgeon that his only option was a fusion which he did not want.

After STAR replacement the talus was realigned back under the tibia with appropriate bone cuts, downsizing the talar component and soft tissue balancing.  The patient is now 5 years out from surgery and very pleased.

 

Salto Total Ankle Replacement

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A 71 year-old female with end stage ankle arthritis and a slight valgus deformity of the talus.

After Salto Total Ankle Replacement the patient is very happy and has a pain-free range of motion of the ankle.

A 63 year-old male with a painful left ankle.  He has a knee replacement on the left knee as well.  Fusion of an ankle joint with a total knee replacement can put added stress on the knee implant.  A total ankle is often a better option.

After Salto Total Ankle Replacement the patient is back to activities of daily living.  He has no pain in his ankle or knee 6 years out from ankle replacement.

 

Revision Total Ankle Replacement

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A 72 year-old female had a STAR total ankle implanted 16 years prior to presenting to Dr. Cottom and Florida Orthopedic Foot & Ankle Center.  She was complaining of a painful left ankle and feeling like she is walking on the “outside” of her foot.

This revision to a Salto ankle replacement was very complicated as there were soft tissue and bone stabilization procedures that had to be done to balance the ankle.  This patient underwent a calcaneal slide osteotomy, subtalar joint fusion, dorsiflexing 1st metatarsal osteotomy and lateral ankle ligament reconstruction.  All of these ancillary procedures were required to balance out her ankle.  We did obtain excellent alignment after the revision surgery.

 

Failed Total Ankle Replacement

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67-year-old female who had an Agility total ankle replacement at an outside institution

Implant subsided with associated pain with every step

The patient did not want a fusion of the ankle

AP view of Agility Total Ankle replacement.  Note the collapse of the implant and narrowing of the ankle joint.

Lateral view of the implant demonstrating subsidence of the talus and collapse of the implant.

This patient did not want a fusion, so a revision Salto XT implant was inserted.  The fibula was reinforced with a plate due to the amount of bone that was removed during the initial total ankle replacement.  Note the revision implant is in excellent position.

Lateral view of the revision total ankle replacement in excellent position.  The patient is pain free and able to walk without difficulty.

 

Takedown Ankle Arthrodesis (Fusion)

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A takedown ankle arthrodesis and conversion can be done in certain situations.  It is an extremely complicated procedure that should only be performed by surgeons who have extensive experience in total ankle arthroplasty.  This type of procedure is done in situations where a non-union, malunion or severe pain is present.  Dr. Cottom has had excellent outcomes with takedown procedures.  Patient selection and surgeon experience is paramount to a successful outcome. 


A 61 year-old female presented to Dr. Cottom complaining of a painful right ankle fusion.

After the fusion was taken down and converted to a replacement.  The patient is doing excellent 5 years after the procedure.

A 55 year-old female presented to Florida Orthopedic Foot & Ankle Center from Kansas for a painful left ankle.  Her fusion was done 12 years prior to seeing Dr. Cottom.  She was having extensive pain in her left lower extremity and was thinking about a below the knee amputation due to the painful fusion.

After a successful takedown ankle arthroplasty, the patient is doing very well and the pain she was experiencing before surgery is gone.

A 60 year old patient presented to the office with a malpositioned ankle fusion and a severe flatfoot deformity that was not addressed.  She was having continued pain in her ankle, foot and knee.

Pre-operative x-rays of her ankle fusion and total knee replacement.

This was a very complicated situation which required rebalacning of both bone and soft tissues below the ankle joint to align the foot under the leg.  The patient underwent a triple arthrodesis and a medial column fusion to obtain proper alignment.

She underwent a takedown arthroplasty of the ankle and was placed in excellent alignment.  This has taken pressure off her knee replacement and she is increasing her activities as each month goes by.

 


 

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