Total ankle replacement, also known as total ankle arthroplasty, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle arthritis. Arthritic changes may be a result of normal wear and tear due to aging or from an injury such as a broken ankle or dislocation. Arthritis eventually leads to loss of cartilage, pain, and/or deformity.
The goal of ankle replacement is to provide pain relief while preserving ankle motion so the patient has less pain and better function during activity.
Ankle replacement is considered in patients that continue to experience ankle pain and decreased function from arthritis after trying non-surgical treatment including anti-inflammatory medication, bracing, physical therapy, activity modification, and
injections. Ankle replacement is not suited for patients with severe deformity or dead bone in the talus, which is the bottom bone of the ankle joint. A history of deep infections of the ankle, significantly abnormal nerve function or sensation
(also known as peripheral neuropathy), inadequate or absent leg muscle function, and poor blood flow of the leg also are signs that ankle replacement should be avoided.
Ankle replacement is performed either under general anesthetic or nerve block. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that recreate the ankle joint. Sometimes additional procedures will have to be done at the same time to ensure the foot and ankle are properly aligned and the deformity is corrected. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implants to heal in place.
Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The procedure is usually performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for many days
after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, some orthopaedic foot and ankle surgeons will allow the patient to start working on gentle range-of-motion activities even if they
are non-weightbearing. Weightbearing usually begins a few weeks after surgery if X-rays show good healing.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels also is a possible complication of ankle replacement. Wound healing is critical in the early weeks as issues with wound healing can lead to superficial or deep infections, and are a greater risk in patients that smoke or have diabetes, or in patients that have rheumatoid arthritis. Another possible complication is the failure of the ankle implant to heal into the bone.
Just as with artificial knee and hip replacements, ankle replacements may have issues arise even years after the initial surgery because there are moving, artificial parts. These issues may require additional surgery and include infection or loosening/wear of the artificial parts.
There are two surgical approaches for treatment of end-stage ankle arthritis: ankle fusion and total ankle replacement. Why should I consider an ankle replacement?
There are many factors that go into this decision, so each individual case should be discussed with your foot and ankle orthopaedic surgeon. In general, when motion of the ankle is preserved in an ankle replacement, the surrounding joints are protected
from increased wear, which is especially important if there is already arthritis in these neighboring joints. The number of ankle replacements being performed is increasing dramatically, with published and ongoing research increasing along with it.
Newer implant designs and improved surgical techniques constantly are evolving with the promise and goal of helping patients with an ankle replacement get results at least as good as their hip and knee counterparts.
Who should I see to have a total ankle replacement?
A foot and ankle orthopaedic surgeon should be seen for management of ankle arthritis. Orthopaedic surgeons who specialize in foot and ankle surgery are specifically trained to perform ankle replacements as well as take care of any complications should they arise.
Original article by Scott Nemec, DO
Last reviewed by David Lee, MD, 2018
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