Ankle replacement surgery, also known as total ankle arthroplasty (TAA), is a procedure designed to relieve pain and maintain motion and function in the ankle joint by replacing a damaged or arthritic ankle joint with an artificial implant composed of plastic and metal.
What is ankle replacement surgery?
In all ankle replacements, the arthritic surface of the upper and lower parts of the ankle joint are removed. These areas of bone are then replaced with the prosthesis, typically composed of a metal surface. A plastic surface is then attached to the tibial component to allow for smooth motion to occur. Newer techniques allow for 3D-printed personalized guides to help remove minimal amounts of bone from patients’ ankles.
Ankle replacement vs ankle fusion: What’s the difference?
An alternative surgical option to ankle replacement is an ankle fusion. Ankle fusion, in comparison to ankle replacement, sacrifices remaining motion in the ankle to provide pain relief. As a result, patients walk slightly slower and with a shorter stride. Ankle fusions do not have a limited lifespan and do not wear out. It is important to note, however, that patients have the same level of satisfaction with either procedure.
When do you need an ankle replacement?
This orthopedic surgery is typically considered when more conservative treatments, such as medication, physical therapy or bracing, have failed to alleviate symptoms. Historically, the treatment has been considered for older or lower-demand patients, as the lifespan of the implant was thought to be between 10-15 years in 90% of cases (less than that of a hip or knee replacement). There have been improvements to the design that have led to this procedure being considered in even younger patients.
Ankle replacement surgery benefits
Total ankle arthroplasty offers several benefits, especially for patients dealing with severe ankle arthritis or joint damage. Here are some of the key advantages:
Pain relief: By replacing the damaged joint with an artificial one, patients often experience a substantial reduction in pain.
Maintained joint function: Unlike ankle fusion, which eliminates joint movement, ankle replacement aims to preserve natural motion. This may improve overall function and allow for a more normal gait.
Enhanced quality of life: Patients often find they can return to many daily activities and hobbies that were difficult or impossible before surgery. These activities may include walking, climbing stairs and participating in low-impact sports.
Reduced need for pain medication: With pain relief from the surgery, patients might find they need fewer pain medications, which may have beneficial effects on overall health and reduce the risk of medication-related side effects.
Preservation of surrounding joints: By preserving ankle motion, the surgery may help reduce the stress and compensatory wear on surrounding joints, such as the knees and hips, which may be affected when ankle motion is lost.
Ankle replacement surgery risks
The unique risks of ankle replacement are that the components may wear out over time and patients may need another procedure in the future. Other risks associated with ankle replacement include:
Infection: As with any surgery, there’s a risk of infection at the surgical site. Infections may range from superficial to deep, potentially affecting the joint and surrounding tissues.
Wound healing: There may be a delay or problem healing the surgical wounds, which may increase the opportunity for infection.
Blood clots: There is a risk of developing blood clots (deep vein thrombosis, or DVT) in the legs after surgery. These clots may potentially travel to the lungs, causing a pulmonary embolism. Patients may be placed on a blood thinner to avoid clots.
Implant failure: The artificial joint may wear out over time or fail due to factors like mechanical issues or poor bone integration. If this occurs, patients will need another procedure to stabilize the ankle.
Stiffness and limited motion: Despite the goal of restoring joint movement, some patients may experience stiffness or limited range of motion after surgery.
Pain: Some pain is expected post-surgery, but persistent or unusual pain may indicate complications, such as implant issues or infection.
Nerve or blood vessel injury: The surgery may inadvertently damage nearby nerves or blood vessels, potentially causing numbness, tingling or circulation problems.
Allergic reactions: Allergic reactions to the materials used in the implant (e.g., metals) may occur, though they are rare.
How to prepare for ankle replacement surgery
Preparing for an ankle replacement surgery involves several steps to ensure the best possible outcome and a smooth recovery.
Preoperative evaluation: Schedule a preoperative evaluation with your orthopedic surgeon. This may include a physical exam, blood tests, and imaging studies (e.g., X-rays, magnetic resonance imaging) to assess the condition of your ankle and overall health. Make sure to review all your current medications with your surgeon. You might need to adjust or stop taking certain medications, especially blood thinners, before the surgery, and address any existing health issues to reduce surgical risks and aid in recovery.
Preoperative instructions: Follow any specific instructions given by your surgeon regarding fasting, medication adjustments or other preparations.
Make your home safe: Prepare your living space for post-surgery mobility. This may include removing tripping hazards, arranging for assistive items like a raised toilet seat or shower chair, and setting up a comfortable recovery area. Depending on your surgeon’s recommendations, you might need crutches, a walker or a wheelchair. Have these items ready before surgery.
Arrange assistance: Arrange for someone to help you with daily tasks and transportation, especially for the first few weeks after surgery. You might need help with cooking, cleaning and personal care. Arrange for transportation to and from the hospital or surgical center, as you will likely not be able to drive yourself after the procedure.
Mental and emotional preparation: Surgery and recovery can be challenging, so it’s important to mentally prepare yourself. Consider discussing any anxieties or concerns with your surgeon or a counselor. Inform family and friends about your surgery and recovery needs. Emotional support can be valuable during the recovery process.
Ankle replacement surgery: What to expect
During the surgery, which is usually performed under general anesthesia, the damaged ankle joint is removed. The surgeon will then implant a prosthetic joint, which typically consists of metal and plastic components. The aim is to replicate the natural movement of the ankle and relieve pain.
Ankle replacement recovery
After the surgery, you'll need to follow a rehabilitation program that includes physical therapy to regain strength and mobility. The recovery period may vary, but it typically involves a period of non-weight-bearing on the affected leg followed by gradual reintroduction of weight-bearing activities.
As an orthopedic surgeon at Boston Medical Center, I find that ankle replacement surgery recovery typically takes six months to a year, and it involves three phases:
Phase I: 4-6 weeks of non-weight-bearing, with at-home range of motion exercises and minimal physical therapy
Phase II: 4-6 weeks of progressing to full weight-bearing, with moderate physical therapy
Phase III: Weight-bearing, with intensive physical therapy