The disease of life

 Undergraduate Education  University of Michigan  Medical School Education  Northwestern University- Feinberg School of Medicine  Residency Training  Northwestern University- McGaw Mecial Center  Fellowship Training- Foot and Ankle  Orthopaedic Associates of Michigan – Grand Rapids  Center for Orthopaedic Research and Education  Foot/Ankle and Fracture specialist

 Commonly affects people >65yo  Over 33,000,000 people are currently affected  It is the leading cause of physical disability  Affects any and all joints

 Autoimmune  Rheumatoid  Psoriatic  Lupus  Infectious  Bacterial  Viral  Posttraumatic  Osteoarthritis  “wear and tear”

 Pain and stiffness  Pain with weather/pressure changes  Swelling and warmth around the joint  Stiffness in the morning that may improve with activity  Pain with vigorous activity

 Nonoperative:  Bracing- double-upright, locked, rocker sole; Arizona  Injections- CSI, hyaluronate  (DeGroot JBJS 2012-, Sun JBJS 2011+)  NSAIDs  Debridement  Distraction arthroplasty Distal tibial Osteotomy  Arthrodesis  Arthroscopic (Better-JBJS 2012)  Open  Arthroplasty

 Ankle has significant less contact surface area as compared to hip and knee  500N over 350mm2 (ankle) vs 1120mm2 (knee) vs 1100 mm2 (hip)  Ankle cartilage is thinner  Soft tissue issues  Ankle sees 5.5x body weight compared to 3x in knee

 Arthritis- OA, posttraumatic, rheumatoid  Charcot Neuroarthropathy  Osteonecrosis of the talus  Failed total ankle arthroplasty  Neuromuscular disorders  Major Contraindications: vascular disease (absolute) and concomitant hind/mid-foot arthritis (relative)

 Uncontrolled diabetes/neuropathy  Noncompliance  Vascular disease  Active Smokers  Patients younger than 50yo  Deformity >10-15deg/ ankle instability  Infection  Ideal patient: older, thin, sedentary, minimal deformity

 First generation- constrained:  cemented, constrained, very stable  Failure: loosening, subsidence, osteolysis  Second generation  Less constrained, less bone resection, no cement  Failure: Polywear, component dislocation  Third generation – semiconstrained  Fixed vs mobile bearing, UHMWPE

 Agility  Inbone  Salto- talaris  STAR

 Total Ankle Arthroplasty  $43,000 (  $46,000 (  Ankle Arthrodesis (“Ankle surgery”)  $15,500 (

 Arthroplasty has been shown in several studies to have a higher rate of complications (especially if adjacent joint arthritis is removed)  The outcomes are at least/most equivalent- patients improve with both treatments  Arthrodesis appears to be cheaper  Arthrodesis has longer-term successful follow up

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