Total Ankle Replacement

Total ankle replacement surgery is used to treat the pain and immobility of severe end stage arthritis that has not responded to non-surgical treatments. The goal of ankle joint replacement surgery is to eliminate your pain and increase the mobility of your ankle joint.

Indications

Ankle joint replacement surgery may be recommended by your surgeon for the treatment of severe end stage arthritis that has not responded to conservative treatment options such as medication or injections.

Arthritis is a general term covering numerous conditions where the joint surfaces wear out.

The joint surface is covered by a smooth articular surface made of cartilage that allows pain free movement in the joint. This surface can wear out for a number of reasons. Often the definite cause is unknown. When the articular cartilage wears out, the bone ends rub on one another causing pain. There are numerous conditions that can cause arthritis and often the exact cause is never known.

Causes of arthritis include:

• Inflammatory diseases such as Rheumatoid arthritis
• Wear and tear of the joint can cause osteoarthritis
• Growth abnormalities of the ankle may lead to premature arthritis.
• Trauma (fracture)
• Increased stress from overuse
• Avascular necrosis (loss of blood supply)
• Infection
• Connective tissue disorders

Other indications for ankle joint replacement surgery include:

• Severe ankle fracture in older patients with osteoporosis, a disease that causes bone loss raises the risk of increased fractures.
• Tumor or growth in the ankle joint
• History of previous ankle surgery

Ankle joint replacement surgery is not appropriate in all cases of ankle arthritis. Ankle fusion may be a better option in some cases. Your surgeon will discuss the best options for you based on your particular situation.

Diagnosis

Ankle conditions should be evaluated by a Foot and Ankle Orthopedic surgeon for proper diagnosis and treatment. Accurate diagnosis comprises of a detailed medical history and physical examination. Imaging tests such as X-rays, Doppler Test, and MRI may also be conducted.

Procedure

Ankle joint replacement surgery is performed under sterile conditions in the operating room under general or regional anesthesia.

Your surgeon will perform the following steps:

• An incision is made over the front of the ankle.
• The muscles are retracted and tendons and ligaments are moved away to expose the ankle joint. Care is taken with nerves to prevent nerve damage.
• The leg bones are then separated from the talus bone.
• The damaged joint surfaces of the tibia and fibula are cut off with a surgical saw to allow for a smooth surface for which to attach the tibial component of the implant.
• Next, your surgeon will cut the top of the talus bone for insertion of the talar component of the prosthesis.
• The tibia and talus bones are then prepared with or without cement, depending on the surgeon’s preference.
• The components are then inserted and put together ensuring proper movement of the prosthesis.
• Screws are inserted above the artificial joint between the tibia and fibula to ensure a tight fit of the new prosthesis.
• A bone graft is taken from the portion of bone cut off and is inserted between the tibia and fibula to create a fusion of the two bones. This helps to prevent loosening of the prosthesis.
• With all the new components the ankle joint is tested through its range of motion.
• The surgeon then irrigates the new joint with sterile saline solution.
• The surgeon then sutures the joint capsule together, repairs the muscles and tendons and sutures the skin closed usually with a drain in place to help any blood drain from the area.
• The ankle is then dressed and bandaged and placed in a splint.

Post-Operative Care

After surgery your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon’s preference.

Common Post-operative guidelines include:

• You will probably stay in the hospital 4-5 days after the surgery.
• Your pain will be managed with a patient controlled analgesia (PCA) machine, injections, or pain pills. A PCA machine enables the patient to modulate deliver a dose of pain medicine on their own.
• Your ankle will be immobilized in a splint with a bulky dressing.
• You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 days.
• Elevating the ankle on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.
• You will not be able to put weight on your new ankle for 6 weeks and will use either a walker or crutches to ambulate during this time.
• Physical Therapy will begin soon after surgery and continue for about 3 months to regain full range of motion of the ankle joint.
• Sutures will usually be removed after 10-14 days.
• Keep the incisions clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.
• You will be given specific instructions regarding activity and rehabilitation.
• Eating a healthy diet and not smoking will promote healing.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

The majority of patients suffer no complications following Ankle Joint Replacement, however, some of complications associated with ankle joint replacement include infection, fracture of the tibia or fibula bone, dislocation of the ankle, damage to nerves or blood vessels, blood clots (Deep Venous Thrombosis), loosening of artificial components, wound irritation, wear, failure to relieve pain, scar tissue build-up requiring revision surgery, instability, stiffness, or weakness of the new ankle joint, and unsightly or thickened scar.

Discuss your concerns thoroughly with your surgeon prior to surgery.