Dr. Steven Haddad, an Illinois Bone and Joint Institute surgeon practicing in Glenview IL, was one of only six surgeons in the country who had access to a new, upgraded version of the Agility Ankle Prosthesis when it first became available in late 2006. Part of the 6-member Evaluations Team for the Agility Ankle LP, Dr. Haddad continues to use the newer technology with much success. The Agility Ankle LP became available nationally in 2007.
According to Dr. Haddad, “there is remarkable improvement in the newly designed prosthesis. It is more stable than the previous design, and poses a substantially lower risk of sinking into the patient’s bone.” Such subsidence is one of the more serious complications of ankle replacement surgery, occurring as early as 2-3 years post-operatively. This may lead to failure of the implant, and necessitate revision surgery. It can happen due to an inadequate support from the patient’s own bone structure, or as a result of inflammatory bone destruction when the plastic lining of the artificial joint wears down.
Additionally, the increased stability is expected to result in a longer-lasting prosthesis. “Longevity estimates suggest that within 14 years following ankle replacement,” says Dr. Haddad, “about 35% of patients require additional surgery.” Like unbalanced tires on a car, unstable artificial ankles wear unevenly due to friction between the metal edge of the prosthesis and the plastic liner within the joint. Such tilting of the components is possible due to instability of the ankle ligaments or pre-existing deformity, and may require revision surgery to re-align the ankle implant. A more stable prosthesis has fewer tendencies towards tilt, and enhances durability of the implant.
The three main reasons that patients require ankle prostheses are trauma, systemic conditions such as rheumatoid arthritis and general joint deterioration from osteoarthritis. Anyone requiring ankle replacement surgery will benefit from the improved design of the Agility Ankle LP, but those with softer bone (such as those with rheumatoid arthritis) and deformity, or tilt, will benefit the most.
Patients who have had prior deep infections, deformity that is extremely severe, or neuropathy from diabetes may not be candidates for this new technology. Such patients should still be evaluated by a surgeon, however, since individual variations may impact such an assessment, and other options exist for treating ankle arthritis.
Dr. Haddad participated with other physicians from Pennsylvania, Baltimore, Minnesota and North Dakota on the Evaluations Team for the device. He was the only Illinois physician in the group and the only Illinois surgeon authorized to use the device during the evaluation period.
Dr. Haddad has been performing ankle replacement surgery since 1999; in 2005 he was the surgeon with the 3rd highest volume of ankle replacements in the United States. He estimates that he has performed ankle replacement surgery on at least one person in almost every state in the country, all of whom have traveled to Glenview for their procedures. It was this wealth of experience that led DePuy Orthopaedics, Inc., the manufacturer of the Agility Ankle LP, to choose him to participate on the Evaluations Team.