Ankle replacement is a surgery for replacing the damaged bone and cartilage in the ankle joint. Artificial joint parts, i.e. prosthetics are used for replacing the bones.
The joint where the tibia (shin bone) rests on top of the talus (a bone of the foot) is called the ankle or tibiotalar joint. Arthritis can affect any joint of the foot including this joint. The smooth cartilage present on the bone surface wears away with time which may cause inflammation, pain, and swelling of the joint.
Ankle replacement surgery helps to eliminate swelling and pain by replacing this damaged joint. Usually performed under general anesthesia, the surgeon will make an incision on your ankle to gain entry into your affected joint. This is followed by the removal of the damaged part of the talus and tibia bones. Next, the surgeon will attach the remaining bone surfaces to artificial metal joints with the help of a plastic piece inserted between them.
Ankle replacement surgeries can be of different types. Ankle replacement is also commonly known as ankle arthroplasty, i.e. replacement of an ankle joint that has been damaged by arthritis with a plastic or metal prosthesis. Osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis are usually the types of arthritis for which ankle replacement is considered.
Types of ankle arthritis
The main types of ankle arthritis include:
- Rheumatoid arthritis: It is a type of autoimmune disease affecting the joints.
- Osteoarthritis: Developing in older adults, it is a type of wear and tear arthritis.
- Arthritis: A past injury that occurred on your joint can cause this type of arthritis.
Your doctor will advise you on other types of treatments like special shoes, physical therapy, pain medicines, corticosteroid injections, and foot inserts for mild to moderate arthritis. Any kind of symptoms that interfere with your routine may require an ankle replacement procedure.
Arthroscopic debridement is a suitable choice for not-so-severe arthritis. However, if it is severe, ankle fusion is an option. Every type of treatment comes with its own set of pros and risks but you may talk to your doctor to decide upon the right type of treatment for your case.
Ankle replacement surgery is meant for those patients who suffer from severe arthritis in their ankle which can lead to symptoms such as severe pain, swelling, stiffness in joints that can lead to difficulty in walking or climbing stairs, stiffness in joints after sitting for too long, pain in joints during and after exercise.
If you are facing any of those symptoms, you should consult a doctor so that he/she can help you decide whether you require surgery or not. In addition to this, the doctor might also recommend any alternative or a less invasive treatment, if it is possible.
If you have the following conditions, this procedure might not be suitable for you:
- If you are having an active or prior deep infection in your ankle joint
- Patients who are having loss of sensation in the foot and ankle
- Severe ankle deformity
- Inadequate bone for supporting the implants
- Neuromuscular disease that can impair muscles which can result in poor muscle tone and function in your ankle.
- Ankle fusion done before
First, you should discuss with your doctor regarding what you should do in order to prepare for the procedure. Ask whether you need to stop taking any medications such as blood thinners. If you smoke, it might be important to stop it before the procedure. Inform your healthcare team about the medicines you take. If there are any changes in your overall health, let your healthcare provider know about this.
Some additional tests such as X-ray, MRI or CT scan might be required before the procedure. You might also need to rearrange your living arrangements, as you will need to use crutches for some weeks. Also, you will need to arrange for someone to drive you home from the hospital after the surgery.
Your doctor will most likely ask you to avoid any food and drink after midnight on the night before the surgery.
Ankle replacement surgery is generally performed by an orthopedic surgeon. He/she will be aided by a team of specialized healthcare professionals. The whole procedure generally takes a few hours.
You will be put to sleep by your doctor with the help of general anesthesia so that you will not be feeling any pain or discomfort during the procedure. The healthcare team will be monitoring your vital signs carefully, such as your blood pressure and heart rate.
After the affected area is cleaned, your surgeon will create an incision through the skin and muscle of the ankle and possibly another one on your foot as well.
Next, your surgeon will be removing the damaged portions of your shinbone and talus. After this, the new metal joint surfaces will be attached into the pieces of your remaining bones. To hold them in place, your surgeon might use a special type of cement. He/she might also need to insert a plastic between the new metal joint spaces, so they are able to glide easily against each other.
If any repairs are necessary, your healthcare provider might make them. Then the layers of skin and muscle around your ankle and foot will be closed by the surgeon.
You may talk to your doctor regarding the expectations from the surgery. You will be under the careful monitoring of your medical team while you are recovering. You might be asked to stay at the hospital for a few days after the surgery.
If you are experiencing pain after the surgery, you might need to take medicines for some relief. You will gradually start experiencing less pain after the surgery.
Your doctor might advise you to wear a splint for a few weeks after the surgery. Alternatively, you can also use crutches for the same for around 4-6 weeks. While you are recovering, you ought to follow the instructions provided by your doctor. You will be able to elevate your legs and rest within the first week after the surgery. However, you might not be allowed to exert full pressure and force on your foot for some months.
The stitches can be removed around 2 weeks after your surgery. In the days following surgery, it’s quite important to keep your foot elevated, as this can reduce any swelling.
For around 4-6 weeks from the date of your surgery, patients should not put much weight on the ankles. After around 12 months, you should be able to return to activities such as walking, hiking, swimming, etc. It is important to avoid high-impact activities as much as possible, such as running or heavy sports. These can decrease the life expectancy of the prosthesis in the ankle.
For regular monitoring of the progress in your condition, ensure that you visit the doctor without missing the follow-up appointments. Your doctor will remove the splint and replace it with a cast or a boot a few weeks after the surgery. For maintaining the range of motion and strength, you ought to perform physical therapy for the first few months after the surgery. When you follow all the instructions from your doctor followed by medicines, rehabilitation, and wound care, you will get better results from the treatment.
Though the surgery is a success in most cases, sometimes there might be few risks such as:
- Blood clot
- Damage to nearby nerves
- The bones not properly joining together
- Bones getting misaligned
- New arthritis in the neighboring joints
- Loosening of the artificial components, which can eventually require a follow-up surgery
- Wearing out of the components
The risk of complications can depend on your age and medical conditions. For example, if you are a smoker or if you are suffering from low bone density, you might have an increased risk of some complications.
People with poorly controlled or uncontrolled diabetes might also have an increased risk. Before you undergo the procedure, it is best to discuss all risks and have all your concerns addressed.
A majority of the patients start walking 4 weeks after the surgery with the help of a protective boot. They are, further, allowed to wear their regular shoes after 8 weeks of treatment.
While the procedure was done on one in every 100,000 cases nearly a decade ago, it had increased to 2.4 for every 100,00 cases now. However, doctors drill try to focus on non-surgical techniques for treating cases of ankle arthritis.
Although the range for success rates of ankle replacement procedures is between 70% and 100%, the mean success rate of an ankle replacement surgery is 90% currently.
Yes, you might experience a little pain after getting treated with the surgery but pain medications are a choice before you get relief from pain to a certain extent.
Yes, an ankle replacement surgery for reducing the pain in the ankle is major surgery. The surgeon will remove the lower part of the tibia and the top part of the talus.
No, most people do not walk with a limp after an ankle fusion procedure and also, experience no pain after the surgery.
You can expect up to an hour for the doctor to finish your ankle replacement surgery. However, many doctors have the chance of finishing up the surgery in as less as 30 minutes where the cases are not complex.