Total ankle replacement

Overview

Total ankle replacement, also known as ankle arthroplasty, is a type of joint replacement procedure. During this treatment, damaged ankle parts are replaced with prosthetics made of plastic or metal. These new components work in conjunction to replicate the motion of a real joint. This treatment method is typically designated for people who experience chronic ankle pain that lasts over time and significantly lowers their overall quality of life.

The goal of ankle replacement surgery is to replace the damaged joint and eliminate the pain and inflammation it causes. The surgery, which is often carried out under general anesthesia, entails the surgeon making an incision around the ankle to obtain access to the damaged joint. The damaged portions of the tibia and talus bones are then excised by the surgeon. The surgeon will affix synthetic metal joints onto the remaining bone areas, with a plastic component interposed between them. 

Reasons for undergoing procedure

Total ankle replacement surgery is commonly employed to address arthritis affecting the ankle joint. Changes in the cartilage, a tough tissue that covers the bones in a joint, lead to arthritis. This cartilage becomes thinner and rougher over time. The development of ankle arthritis is a natural part of becoming older and results from the cumulative consequences of regular use. Additionally, it may be brought on by repetitive ankle traumas, ankle fractures, or particular underlying medical conditions.

The symptoms of ankle arthritis may include joint pain, joint swelling, and difficulty in walking.

Most people find relief from ankle pain and related symptoms by using a combination of basic treatments, often referred to as “conservative treatments” in the medical field. These encompass various approaches, including the use of medications, participation in physical therapy, and the adoption of orthotic remedies such as custom shoe inserts or braces. However, in cases of severe ankle arthritis, more focused treatment might be necessary. In such situations, a medical professional might recommend total ankle replacement surgery.

Risks

Ankle replacement facilitates the restoration of strength and stability to the ankle, while also preserving its range of motion. The replacement components articulate or move in a manner similar to your natural joint. This flexibility enables you to walk in a regular manner, experience reduced pain, and resume a more dynamic lifestyle.

Although total ankle replacement surgery often has a high success rate in most cases, it is not without underlying risks. These potential dangers include, among others:

• Infection
• Nerve damage
• Bleeding 
• Blood clot
• Inadequate fusion of bones
• Improper positioning of the bones
• Development of arthritis in adjacent joints
• Loosening of the synthetic components, potentially necessitating subsequent surgical intervention
• Deterioration of the components over time

Factors like age and existing medical conditions can impact a person’s vulnerability to complications. For instance, individuals who smoke or have low bone density might have higher risk of specific problems. This also applies to individuals with uncontrolled diabetes, who could be at greater risk as well. It’s crucial to have a thorough conversation with a healthcare provider about all pertinent concerns, particularly the risks that directly relate to the patient’s condition.

Before the procedure

It is essential to have a realistic perspective when preparing for surgery and the accompanying rehabilitation period. It is crucial to have conversations with the members of the care team on how to get ready for the treatment. The ability to anticipate obstacles and create a thorough recovery plan are made possible by being aware of what is ahead. The healthcare provider may recommend starting physical therapy, quitting smoking, and stopping the usage of certain drugs before the surgery.

Prior to the scheduled procedure, it might be necessary to undergo supplementary imaging examinations such as X–rays, CT scans, or MRI scans.

It is recommended to discuss the likely course of recovery with family and friends. Mobility issues following a total ankle replacement are anticipated. Making a plan to handle daily chores becomes essential as a result. It can include getting help with chores like grocery shopping, climbing stairs, or taking care of animals.

During the procedure

Only an experienced orthopedic surgeon should be tasked with performing a total ankle replacement.  The surgeon is a member of the medical team, working alongside an anesthesiologist, nurses, and other medical experts. Together, this medical team will: 

• Provide general anesthesia or a nerve block to avoid pain or discomfort during the procedure.
• Make an incision along the frontal aspect of the ankle.
• Eliminate the degenerated (worn–down) bone and cartilage.
• Prep the joint surface to accommodate the new prosthetic components.
• Insert the prosthetic pieces and assess the joint’s range of motion.
• Execute additional procedures as necessary to ensure optimal alignment of the ankle and foot.
• Surgically close the skin and muscle around the foot and ankle. 

Generally, total ankle replacement is conducted as an inpatient procedure, with patients often requiring an overnight stay in the hospital post–surgery. In certain cases, selected patients might be eligible for outpatient total ankle replacement surgery.

After the procedure

Following a surgical procedure, individuals might experience intense pain, which can be effectively managed with painkillers. As time passes, this distress should progressively diminish, reaching a point of lesser intensity than what was felt prior to the surgery. While the surgical incision might not be immediately apparent, it is crucial to promptly notify the healthcare provider in case there is a surge in pain, the onset of a high fever, or the occurrence of chills. 

Patients are advised to have a conversation with their healthcare provider regarding the anticipated post–surgery experience. The medical team will closely monitor the patient’s recovery process. 

Upon awakening, it’s likely that your leg will be immobilized and raised. You can return to your regular diet once you’re capable of doing so. Follow–up X–ray assessments might be arranged to evaluate the results of the surgery. In general, patients should be prepared for a hospitalization period lasting a few days. 

Outcome

An ankle arthroplasty recovery period lasts six to twelve months on average. Typically, people who are in a cast or splint use crutches or a walker. The goal of the splint or cast is to keep the ankle immobile in order to help the healing process. The healthcare professional might suggest taking medication during this interval to lower the risk of blood clots. 

Engaging in post–surgery physical therapy can assist you in restoring mobility to your ankle. The rehabilitation process might encompass: 

• Training to improve the standing and walking (gait training).
• Application of massage techniques to reduce swelling.
• Strengthening exercise
• Stretching exercise to enhance the range of motion and flexibility.
• Weight–bearing activities that increase in intensity over time.

Attending all scheduled follow–up appointments will enable the healthcare provider to monitor progress effectively. Several weeks following the intervention, the patient’s splint can be taken off and substituted with a boot or cast. After an additional few weeks, the cast may be removed.