How to get a quota for ankle replacement? We will understand this in this article.
Endoprosthetics is a surgical procedure, during which the doctor removes the damaged elements of the ankle joints, and an artificial implant is installed in their place. The operation is done with traumatic, degenerative, destructive, rheumatic and infectious ankle lesions. The main indication for surgery is severe leg pain that does not go away. Compared to replacing the hip and knee joints, ankle joint replacement was started much later. The first such operation was performed in the seventies of the last century. Since then, about thirty different ankle prostheses have been created. Currently, no more than ten of them are used in clinical practice.
Endoprosthetics and features
Ankle replacement surgery is a rare operation. About three thousand such replacements are made in the world per year, while the total number of replacements of various other joints is three hundred thousand annually.
It is worth noting that some surgeons are skeptical of such a procedure as ankle replacement, preferring to do arthrodesis for patients. Not everyone is in a hurry to take risks, since you can perform an already verified operation. But recent scientific studies have shown that ankle replacement is highly effective. To date, the total replacement of the ankle by competent doctors is considered as the method of choice in the treatment of severe osteoarthrosis.
Unsuccessful outcome - reasons
If we talk about the unsuccessful outcome of endoprosthetics, then the cause was previously difficulties in reproducing the biomechanics of the ankle joint. Fortunately, today all these problems have already been resolved. Nowadays, doctors stopped using acrylic cement, having developed better access to the joint, and began to use improved designs of the endoprosthesis. All this makes it possible to avoid unsuccessful operations and achieve a good functional result.
Next, we find out what the essence of such an operation as ankle replacement is.
What is the essence of this operation?
As you know, the surface of three bones takes part in the formation of ankle joints: fibula, tibia and talus. They, as a rule, are tightly adjacent to each other, being fixed by ligaments and articular capsules. During endoprosthetics, doctors remove the destroyed cartilage, and in addition, a partial bone resection is performed. After this, an endoprosthesis is installed.
It is noteworthy that ankle replacement in Russia is most often done under spinal anesthesia. Much less often, this operation is performed under anesthesia. Immediately after the operation, the patient is given gypsum, in which the person walks for a month and a half. It should be noted that the real rehabilitation, as a rule, begins only after removing the retainer.
Difference from arthrodesis
Differing from arthrodesis, arthroplasty makes it possible to maintain mobility of the ankle joints. After surgery and rehabilitation, the patient has the opportunity to walk, swim, run, and in addition, ride a bicycle or go skiing.
Now we turn to the examination of indications and contraindications for such surgical treatment.
Indications
In which case do ankle replacement work?
The main indication for the replacement of the ankle joint is the presence of severe pain along with a violation of the mobility of the foot, which occurs due to serious illnesses and injuries. It is worth noting that such an operation is done only if the conservative treatment is ineffective. We name diseases in which a person may need ankle replacement:
- The presence of contracture, that is, a persistent restriction of joint mobility.
- The presence of ankylosis, accompanied by severe pain.
- The development of deforming osteoarthrosis of a traumatic, degenerative or destructive nature.
- The development of severe rheumatoid arthritis.
It should be noted that deforming osteoarthritis of the ankle joint often occurs in people with flat feet. But this pathology can often develop after injuries. The reason for this may be damage to the bone cartilage along with rupture of ligaments or improper fusion of the tibia after fractures.
What is more often performed - arthrodesis or ankle replacement?
Ankle injuries are in second place, second only to torn menisci. According to statistics, 35 percent of people who have suffered severe traumatic ankle damage require endoprosthetics. But, unfortunately, instead of replacing the ankle joint, doctors often perform arthrodesis for such patients.
Contraindications
The following diseases and conditions are prohibited for this operation:
- The presence of severe osteoporosis of the bones of the foot and lower leg.
- The presence of instability in the ankle joint.
- The development of hallux valgus.
- The occurrence of aseptic necrosis of the talus.
- The appearance of scars or trophic changes in the skin around the ankles.
- The development of inflammatory processes in the lower region of the limb.
- The occurrence of pseudoarthrosis after undergoing arthrodesis.
- Damage to the ankle due to trauma.
- The presence of an immunodeficiency state or infection.
- Long-term treatment with steroids shortly before surgery.
Endoprosthesis Selection
During the planning of endoprosthetics, the surgeon selects the most suitable endoprosthesis for the patient. For this, x-rays are used. As a rule, a specialist applies standard templates to the radiograph. The choice of prosthesis is influenced by many different factors, in particular the patient’s age, the presence of osteoporosis, and in addition, the degree of joint destruction and the like. The main types of prostheses are the following variations:
- Associated Type. Such a prosthesis has only one axis of rotation, which is why it cannot provide a full range of movements. Unfortunately, such prostheses become loose very quickly, leading to joint instability. The only advantage of such an endoprosthesis is the persistent fixation of their ingredients among themselves. To date, such designs are almost never used.
- Unrelated type of prosthesis. Such prostheses rotate around several axes and provide maximum mobility. They hardly shake, providing a good long-term result. Unfortunately, such prostheses often cause damage to adjacent soft tissue.
- Cement prostheses. This variety is fixed using special cement. Previously, only endoprostheses based on cement fixation were used in orthopedics. In recent years, they have been gradually superseded by cementless models.
- A cementless prosthesis is fixed using a tight fit technique. Over time, such prostheses seem to grow together with the bones, and because of this they are extremely rarely loosened. It is worth noting that today the three-component models, which differ in cementless fixation, are considered the most qualitative.
The cost of ankle replacement is of interest to many.
Features of the operation
After anesthesia, the surgeon cuts the soft tissue and removes the joint capsule to the maximum. This makes it possible to perform bone resection efficiently and to install the prosthesis without interference. It is worth noting that the choice of operative access to the ankle joint depends on the model of the endoprosthesis. The main requirements for the incision during the intervention are the following recommendations:
- The anatomical requirements must be observed.
- It requires a complete absence of angles, which can be close to ninety degrees.
- Proper synovectomy is required.
Tibia resection is always done especially sparingly. Whenever possible, doctors always maintain the maximum amount of bone tissue. This makes it possible to avoid shortening of the limb and, if necessary, allows high-quality arthrodesis in the future. After resection, the surgeon sets the prosthesis according to the “press fit” technique. In the event that the implant design requires it, bone cement is used along with special screws. Reviews and consequences of ankle replacement are discussed below.
Patient rehabilitation
After surgery, gypsum is applied to the patient’s leg, allowing the joint to be fixed and allowing time to take root. The patient begins to get out of bed immediately the next day after arthroplasty. A person is allowed to walk with crutches after five days.
It is worth noting that active rehabilitation after replacing such a joint begins eight weeks after removal of the cast. At this time, specialists train the patient on orthopedic simulators, carrying out myoneurostimulation. An excellent effect is provided by exercises on exercise bikes, walking, and in addition, physiotherapeutic procedures.
Reviews
Reviews of ankle replacement are mostly positive.
Surgical intervention makes it possible to get rid of chronic pain that has been disturbing for a long time. Regarding the gait, we can say that it remains the same or improves slightly. Unfortunately, the endoprosthetics procedure does not allow to restore the biomechanics of the ankle joints completely. But the installed prosthesis gives the patient the opportunity to move normally. Ten degrees of the back and plantar flexion of the endoprosthesis are enough to move and perform the usual everyday actions.
According to statistics, ninety percent of patients are satisfied with the results of such an operation. All of them noted the disappearance of the pain syndrome, and in addition, the restoration of the supporting ability of the limb was reported, as well as an improvement in the quality of life. Thus, the endoprosthetics procedure is a high-quality and promising treatment technique compared to arthrodesis.
Quota endoprosthesis replacement
If a person has indications for endoprosthetics at the Federal Bureau of Medical Social Expertise, the patient can draw up the necessary documents in order to obtain a quota. You will not have to pay for the operation, as well as for the endoprosthesis. But one must understand that the receipt of a certain quota is usually always associated with the execution of various documents and a certain (sometimes long) waiting period for the operation.
Everyone has a compulsory medical insurance policy. Thus, the Federal Bureau of Medical Social Expertise can be contacted with only a passport with a compulsory medical insurance certificate. If ankle replacement surgery is necessary in Moscow and the regions, all treatment (i.e. hospitalization, surgery, medication and rehabilitation), with the exception of some implants, is paid for by the policy. The cost of endoprostheses varies and directly depends on the individual characteristics of the patient.
It should be borne in mind that there will most likely be a large queue for hospitalization. But if there is no opportunity to wait in line, then you can always use paid services. The cost of such treatment is calculated individually. It usually includes rehabilitation procedures, treatment conditions (single or double room), the cost of prostheses, surgical services and so on.
Price
In many ways, the cost of the operation depends on the price of the endoprosthesis itself. Most of them in Moscow and in the regions range from 160 to 180 thousand rubles. The selection of a suitable prosthesis is one of the most important components of a successful operation. In general, the cost of ankle replacement in Russia today, together with the work of a surgeon and a comprehensive examination, is at least four hundred thousand rubles, regardless of region.