Total Ankle / Ankle Replacement Surgery for Arthritis
Edited By: Sigvard T. Hansen, Jr., M.D.
Last updated Monday, August 20, 2007
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Summary
Overview
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.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.
Types of surgery recommended
Often, treatment of ankle arthritis only requires restricting the
patient's activities to things that are not painful, and making certain
that the shoe is comfortable. In general, a shoe that laces up above
the ankle and has a cushioned heel will be more protective than other
types of shoes.
Bracing of the ankle is another option. This can be provided by a
device known as an ankle lacer. It fits inside the shoe and laces up
like an old-fashioned boot. A third option for more significant pain is
an AFO, which stands for Ankle Foot Orthosis. This is a plastic brace
that goes along the back of the leg and the underside of the foot and
also fits inside the shoe. This requires a slightly larger than normal
shoe size.
Who should consider total ankle / ankle replacement surgery?
The decision to have surgery is primarily based on pain that interferes
with activities one usually performs in the course of a day. When this
pain cannot be controlled by bracing or over-the-counter medication, it
is appropriate to consider surgery.Surgical options
Surgical options include arthrodesis and ankle replacement (or total ankle arthroplasty).
Arthrodesis is the connection between the tibia, fibula and talus.
This operation is excellent for pain relief but sacrifices the
up-and-down motion of the foot that normally occurs through the ankle.
The talus is permanently fixed to the end of the leg bone.
Ankle replacement is a procedure that has been available for
approximately 25 years. However, it has not been as successful as hip
and knee replacement surgery. Because the ankle is not as often
involved in arthritis, there has been less study devoted to this area.
Over the last 10 years ankle arthroplasty has been growing in
popularity as the implants available for replacement have improved.
Current studies indicate about a 90 percent patient satisfaction rate
in the first four years after surgery. One anticipated problem in the
future may be loosening of this artificial ankle. An orthopedic
surgeon should help you make the decision if you might be a candidate.
Risks
The vast majority of these surgical procedures move forward without risk.
However, risks include, but are not limited to:
- infection
- injury to nerve or blood vessels
- fracture of the bone
- failure of the bone to heal to the ankle replacement
- failure of the bones to heal together
- wound problems
- blood clots
There are also rare cases of pain syndromes reported from any foot,
ankle, hand, or arm surgery. There are also risks of anesthesia, which
you should discuss with the anesthesia team.Preparation
Before any surgery is planned, medical conditions involving the
heart, lung, or kidney need to be evaluated by a primary care
physician.
Any infections that might be present anywhere in the body need to be
treated, and smoking should be discontinued. The surgeon should be made
aware of any allergies or medications that you might be taking.
Plan home and work activities to include six weeks of time after
surgery when you won’t be able to participate in your normal activities.
Technical details
The skin incision will be primarily in the front of the ankle with smaller incisions on the outside.
The foot bone is replaced with a smooth metal surface and a high-density polyethylene (plastic).
You will wake up from surgery in a dressing that is hard in the back
and soft in the front, which will protect your foot and ankle and allow
swelling.
Length of total ankle / ankle replacement surgery
The surgery itself takes approximately two and a half hours.Pain and pain management
Patients are given a combination of intravenous and oral narcotics to
control the pain postoperatively. If a patient has the surgery under a
block, the leg may remain numb for six to 18 hours after surgery.Hospital stay
You will be admitted to the hospital the morning of surgery and stay in
the hospital for approximately two to three days, until you have
adequate control of your pain and can walk safely on crutches or a
walker.Hospital discharge
Patients are discharged home from the hospital when they can walk
safely using crutches and when their pain is controlled without
intravenous medication.Follow-up
You will return to the clinic in two weeks for suture removal but
continue to have the leg protected and maintain crutch usage. At six
weeks after surgery, X-rays will be performed and a decision will be
made whether to advance weight bearing or continue the crutch usage.
You will put about 50 percent of your weight on the operated leg for
about four weeks.
The rapidity of the progress in weight bearing will depend on what
other procedures need to be done to correct your individual deformity.
When to see a doctor
Please call a physician if the patient has:
- New onset of swelling, tingling, pain, or numbness in your toes
that is not relieved by elevating your foot above your heart for one
hour.
- Drainage that is foul smelling, green or yellow, or drainage where there was none before.
- You have chills or a temperature above 38.5° C (101.3° F).
Surgery for arthritis of the ankle at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-731-4830 to make an appointment. Our clinical center is located in Seattle Washington, USA