Top Foot Doctors in Baltimore Offer Ankle Transplant Replacement at Mercy

Foot and Ankle Reconstruction at Mercy - Baltimore

At The Institute for Foot and Ankle Reconstruction at Mercy in Baltimore, our foot and ankle surgeons are highly skilled in performing ankle transplant replacement as a treatment option for ankle arthritis. Dr. Mark Myerson, Medical Director, is a pioneer in treating complex foot and ankle conditions.

What is Ankle Transplant Replacement?

Ankle transplant replacement, or ankle allograft transplant replacement, offers a unique alternative to the management of ankle arthritis

In an ankle transplant replacement, an entirely new joint surface made of bone and cartilage from a fresh cadaver is implanted instead of replacing the ankle joint with metal and plastic. This essentially amounts to what can be considered a transplant of a new ankle, since the fresh bone and cartilage is transplanted from a cadaver replacing the arthritic ankle that is removed completely.

An ankle allograft replacement allows a more normal “function” though the movement may not be perfect. The main advantage of the ankle allograft transplant replacement is the return of some freedom of movement in the ankle. This movement is important for walking, exercise and climbing type activities. 

Full movement of the ankle joint is not likely regained but it is far preferable to the lack of movement in the fused ankle. The success rate of the ankle allograft transplant replacement has been good.

NEXT: How is an Ankle Transplant Replacement performed?  ›
How is an Ankle Transplant Replacement performed?

An ankle transplant replacement involves removal of a segment of bone and cartilage from the arthritic ankle and then the identical bone cuts are made on the ankle cadaver graft using specialized instruments that cut the graft in the exact size and shape. The most important aspect of the transplant is the correct sizing to perfectly match the ankle.

NEXT: Who should receive an Ankle Transplant Replacement?  ›
Who should receive an Ankle Transplant Replacement?

The best candidate for an ankle transplant replacement is a patient who is younger and much more active. It is used more specifically for the younger patient who would normally require an ankle fusion (arthrodesis), but for whom there are complicating features where an ankle fusion is not the ideal operation. 

This is particularly the case in patients who have ankle arthritis in both ankles where a fusion of both ankles is really debilitating or in patients who have arthritis of both the ankle and other additional joints in the back of the foot, so that if an arthrodesis has to be performed, it would have to be more extensive. Dr. Mark Myerson rarely uses the ankle transplant for the elderly, more sedentary individual. 

NEXT: What is the process if I am a good candidate for Ankle Transplant Replacement? ›
What is the process if I am a good candidate for Ankle Transplant Replacement?

The decision that an ankle transplant replacement is the best treatment option for a patient with ankle arthritis is made after careful examination. The size of the ankle is measured by computer analysis and the measurements are sent digitally to a tissue bank. The tissue bank searches for the exact size and then harvests the ankle from a cadaver.

It may take from one week to one year to find the exact donor for the ankle. This does not depend on tissue matching as must be done with other organ transplants. Instead, our surgeons have to obtain a perfect size match for the patient’s ankle. This takes a lot of work on the part of the bone graft company with which the surgeons at The Institute for Foot and Ankle Reconstruction work.

Once a patient is on the waiting list for the ankle transplant replacement, the patient needs to be available at all times to have surgery. This may be an inconvenience but it takes a lot of work on the part of the bone graft company to find the perfect match for the patient and our surgeons do not want this to be wasted.

Once a graft size match has been identified, our surgeons are notified by the company and then the graft is subjected to very stringent infection testing. This is extremely important and neither our surgeons nor the company will perform any graft unless this has been completely cleared medically. It may take up to three weeks to clear infection control adequately.

Our surgeons try not to involve the patient in this process until the graft has been released, but this can be difficult, since patients will need to make travel, family and work arrangements. For this reason, our surgeons often will inform the patient of the availability of a size match early on, but often the majority of grafts do not pass through infection control. This can be very frustrating, but is better than finding out at the last moment, when the patient is unable to arrive in time for the surgery.

Once the graft has been released to the surgeons, it must be implanted it immediately, since the success of the ankle allograft transplant replacement depends upon the presence of living cartilage cells. These have a limited life span, and for this reason, our surgeons want to perform the surgery as soon as possible once the graft is released.

Once a patient is on the waiting list, our surgeons ask the patient to inform them immediately if home or work circumstances change such that the patient will not be able to go through with the surgery in the near future.

NEXT: What is the benefit of having an Ankle Transplant Replacement? ›
What is the benefit of having an Ankle Transplant Replacement?

The main advantage of an ankle transplant replacement is the potential for replacement of the entire ankle joint with viable living cartilage cells. In the cases performed at The Institute for Foot and Ankle Reconstruction at Mercy, there does not appear to be any immune response or rejection of the implanted material. 

It seems that unlike other transplanted tissue, there is not sufficient bone or cartilage for this to be recognized as foreign and then rejected.

NEXT: What is the recovery process following an Ankle Transplant Replacement? ›
What is the recovery process following an Ankle Transplant Replacement?

The recovery following the ankle transplant replacement is very carefully monitored. Rehabilitation and exercise are essential. Dr. Mark Myerson’s approach to rehabilitation includes an exercise bicycle and therapy in a swimming pool. Rehabilitation begins as soon as the stitches are removed and the incision is healed. These exercises facilitate the range of motion and ultimately improve the final outcome of the ankle transplant replacement.

NEXT: Why have an Ankle Transplant Replacement at Mercy?  ›
Why have an Ankle Transplant Replacement at Mercy?

The ankle allograft transplant operation requires a very specialized team of ankle reconstructive surgeons as well as a good working bone bank to provide the donor graft required for implantation. Dr. Mark Myerson and the surgeons at The Institute for Foot and Ankle Reconstruction at Mercy are highly skilled in managing ankle arthritis and in determining when an ankle transplant replacement is the best treatment option. 

Our foot and ankle reconstructive surgeons work closely with a tissue bank that implements extremely strict precautions to help ensure the transplant process is completely sterile and there is no infection possibly present in the transplanted tissue.   

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