Total Ankle Replacement (Arthroplasty)
What is Total Ankle Replacement?
Total ankle replacement (also called ankle arthroplasty) is a surgical option for patients with arthritis of the ankle. This operation can relieve pain and maintain motion in the arthritic ankle joint and is an alternative to arthrodesis (ankle fusion) which can relieve pain but eliminates motion in the joint. Although it does not have the same long-term track record of hip or knee replacement, shorter-term studies on ankle replacement look very promising.
Although total ankle replacement is not as common as total hip or total knee replacement, advances in
implant design have made it a viable option for many people.
Ankle replacement is most often recommended for patients who have:
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Advanced arthritis of the ankle
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Arthritis that has destroyed the ankle joint surfaces
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Ankle pain that interferes with daily activities
Ankle replacement relieves the pain of arthritis and offers patients more mobility and movement than fusion.
In addition, being able to move the formerly arthritic joint means that less stress is transferred to the
adjacent joints. This lessens the chance of developing adjacent joint arthritis.
As in any type of joint replacement, an ankle implant may loosen or fail over the years. If the implant failure
is severe, the replaced joint can be exchanged for a new implant — this procedure is called a revision
surgery.
Another option is to remove the implant and fuse the joint. This type of fusion is more difficult than when
fusion is done as the initial procedure. When the implant is removed, there is space in the bone that must
be filled with bone graft to maintain the length of the leg. Because the new bone may not be as strong, the
risk of nonunion is greater.
Characteristics of Arthritis of the Ankle
The ankle joint is made up of the two bones of the lower leg and the first bone in the foot called the talus. It is often called the tibiotalar joint.
This joint can lose its cartilage covering either through injury, infection or wear and tear. X-rays will show a narrowed joint with other changes the physician will evaluate.
Recovery
In most cases, surgery relieves the pain of arthritis and makes it easier to perform daily activities. Full recovery
can take from 4 to 9 months, depending on the severity of your condition before surgery and the complexity of
your procedure.
Foot and ankle surgery can be painful. While you should expect to feel some discomfort, advancements in pain
control now make it easier for your doctor to manage and relieve pain. Immediately after surgery, you will be given
medication for pain relief. If needed, your doctor will provide you with a pain reliever that you can take for a short
time while you are home.
Your doctor will most likely apply a cast after surgery to limit movement in your foot and ankle and to prevent
nonunion. To reduce swelling, it is important to keep your foot elevated above the level of your heart for 1 to 2
weeks after surgery.
Later in your recovery, your doctor may recommend physical therapy to help you regain strength in your foot or
ankle and to restore range of motion.
In most cases, you will be able to resume your daily activities in 3 to 4 months although, for a period of time, you
may need to wear supportive shoes or a brace.