Total Ankle Replacement

What is a total ankle replacement?

Total ankle replacement, also known as total ankle arthroplasty, is a treatment option offered to patients in whom non-surgical options have been ineffective in controlling pain due to ankle arthritis. Arthritis or joint inflammation of the ankle can develop due to acute or chronic conditions such as injuries (ankle fractures or dislocations), leading to stiffness, pain and difficulty walking, or just normal wear and tear. The ankle joint is the connection point of the lower leg bone (tibia) and upper foot bone (talus). Normally, the ends of these bones are made up cartilage that allows the lower leg and foot to move in smooth, painless motion. In arthritic patients, depending on the degree of cartilage loss, pain, and deformity, limited mobility can occur.

Until recently, advanced arthritis that is very painful has been treated primarily with ankle fusion. This procedure obliterates the ankle joint completely. Pain is relieved, but at the cost of absolute stiffness. A newer procedure gaining popularity has been total ankle replacement. Total ankle replacement involves removal of arthritic bone and cartilage and replacement with implants made of metal and plastic. These components allow the ankle joint to move smoothly, mimicking the cartilage that was lost.

How is it determined that a total ankle replacement is needed?

Total ankle replacement may be recommended for failure of conservative treatments, including anti-inflammatory medications, Tylenol, bracing, physical therapy, activity modification, or injections, and for patients who continue to experience ankle pain and decreased function from arthritis. The procedure is not recommended for severe deformity, dead bone in the talus (ankle bone), soft bone, history of deep ankle infections, peripheral neuropathy, inadequate/absent leg muscle function, and poor blood flow to the leg.

What occurs during total ankle replacement surgery?

Ankle replacement is usually performed under general anesthesia with or without a nerve block. A thigh tourniquet is used to control bleeding and improve visualization during the surgery. The incision for the procedure will be from the front or side of the ankle, depending on the implant being used. The bone is cut and remodeled, and the metal and plastic components are placed to recreate the ankle joint. If other deformities are present, additional procedures may be done at the same time to ensure the alignment of the foot and ankle. The incisions are closed using stitches or staples, and a splint is applied.

How long does a total ankle replacement procedure take, and how long is recovery?

The overall procedure will take approximately 2-3 hours. Most patients are discharged in 23 hours with an overall recovery period between 6-12 months. Crutches or a knee scooter can be used after the surgery to assist with movement. Patients can start weight-bearing in a controlled ankle movement (CAM) walker boot in 2-3 weeks, once the incision heals and X-rays demonstrate good bone healing. The ankle replacement components will likely last for at least 10 years, but it can vary depending on the patient’s health and activity level.

What are the benefits and risks of total ankle replacement surgery?

The primary benefit of total ankle replacement is decreased pain. Some, but not all patients, may experience increased range of motion with better mobility. The risks include infection, wound healing,  injury to blood vessels and/or nerves, blood clots, fracture, failure of bone to heal and loosening of implant components. Your Rubin Institute for Advanced Orthopedics doctor can evaluate your particular situation and advise you on the relative risks and likelihood of success after total ankle replacement.

Why choose the International Center for Limb Lengthening for total ankle replacement surgery?