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mahadevan
consultant foot and ankle surgeon
What is an ankle replacement?
A total ankle replacement is a surgical option for patients with arthritis of the ankle. The worn surfaces of the joint are removed and resurfaced with a metal joint. High-density polyethene is inserted between the metal surfaces and acts as the bearing surface (see X-rays below). This procedure relieves pain whilst maintaining ankle movement unlike an ankle fusion (arthrodesis) where joint movement is eliminated.
Ankle arthritis
Total Ankle Replacement
Ankle replacement versus Ankle fusion
Each surgery has it's pros and cons and not every procedure is suitable for every person. Your overall health, age, and activity level will be assessed to help decide whether ankle replacement or ankle fusion is best for you.
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If you are of a younger age or are physically very active, a fusion may be a better option because the longevity of an ankle replacement is less predictable. Other indications for an ankle fusion include pre-existing severe ankle deformity, poor soft-tissue around the ankle and being overweight. An ankle fusion is a permanent fix for ankle arthritis but the drawback is loss of motion.
On the other hand, ankle replacements relieve pain whilst maintaining ankle motion. The recovery following this procedure is also quicker than a fusion. However, ankle replacements wear out with time and pain may reoccur. When this happens revision surgery (conversion to fusion / new implant) may have less predictable results. There is also a higher re-operation rate after an ankle replacement compared to an ankle fusion.
How is it done?
This procedure is usually performed under general anaesthetic and frequently combined with a nerve block for pain relief. Occasionally a spinal anaesthetic may be recommended. The operation takes about 2 hours. You will be admitted on the day of operation and kept in overnight.
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Surgery is done through an incision on the front of the ankle. The damaged joint surfaces are removed and prepared for the implant. The implant is then impacted onto the bone to obtain a press-fit.
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Your ankle will be protected initially in a plaster for 2 weeks. You may rest the foot down to the ground for balance but not take any weight on the operated ankle. After 2 weeks the plaster is removed and you will use an ankle boot for another 4 weeks. At this stage you start taking weight through the ankle. You will therefore be on crutches for a few weeks.
Aftercare & FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. Your first clinic appointment is usually 12 - 14 days after surgery to remove the plaster.
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Wound care – The plaster should be kept dry. At yours first clinic appointment, wound inspection and suture removal will be undertaken.
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Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If not, you may need to stay off work until the boot is removed.
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Driving - You will not be able to drive for at least 6 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
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Flying after surgery - It is generally recommended to wait at least six weeks to fly. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
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Infection
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Nerve damage – causing numbness and painful scar
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Fracture
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – to reduce this risk you would be prescribed heparin injections for a few weeks (unless contraindicated)
Loosening of implant
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Residual pain in other joints
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Prolonged recovery
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.