Until the mid-1990s, the only option for patients with long standing ankle arthritis and those with post traumatic arthritis due to severe ankle fractures was an arthrodesis. "We don't think about it, but this small joint is responsible for carrying a person's total body weight,” says Dr. Roy Sanders, chief of Orthopedic Surgery at Tampa General Hospital (TGH) Orthopedics Institute and Florida Orthopaedic Institute. "As a result, an ankle joint implant needs to fit precisely and have a long life."
Dr. Sanders played an integral role in the advancement of ankle replacement surgery, helping design the second-generation prosthesis and becoming the third surgeon in the U.S. to perform routine ankle replacement surgery. With the newer designed third-generation implants, Sanders and the team at TGH use innovative surgical techniques such as patient-specific instrumentation (PSI). With this technique the patient obtains a CT scan to be used by the implant manufacturer to create a 3D-printed model of the patient's ankle. The surgeon can then use that model to customize implantation for each patient.
"This technology is amazing. A completely custom mirror image of the anterior tibia and talus can be created to perfectly position the reference wires, which then allow an anatomically correct placement of the implants," Sanders said. "This makes it possible for us to make the most precise cuts and the outcomes are much better."
The customized fit means the prosthesis lasts longer and the patient's mobility and function improve. Sanders and the team at TGH and Florida Orthopaedic Institute has performed hundreds of ankle replacements, more than at any other center in Florida. Tampa General Hospital is already prepared for the next iteration in ankle replacement surgery which will use robotic techniques.
"I believe that using robotic technology to prepare the tibia and talus will improve the positioning and bone-implant interface further, making this an even more reproducible and longer lasting procedure than it already is,” says Sanders.