Ankle Replacement Surgery: Use, Procedure & Risks
Ankle Replacement Surgery involves the replacement of damaged bone and cartilage within the ankle joint. This procedure utilizes artificial joint components, known as prosthetics, to replace the patient’s own bones. Various forms of ankle replacement surgeries exist. While ankle replacement surgery has been accessible for more than 20 years, it is not as widely performed as hip or knee arthroplasty. This is primarily due to the lower occurrence of osteoarthritic ankle conditions. Most cases of ankle osteoarthritis are caused by trauma rather than being of unknown origin (idiopathic). Interestingly, such cases are more prevalent among younger patients. This article will focus on total ankle replacement.
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Image source: Barg, A., Wimmer, M. D., Wiewiorski, M., Wirtz, D. C., Pagenstert, G. I., & Valderrabano, V. (2015). Total ankle replacement: indications, implant designs, and results. Deutsches Ärzteblatt International, 112(11), 177.
(Modern ankle implant types a) Components with tibial stem b) Components with bars c) Flat components)
Table of Contents
The procedure of ankle replacement surgery
During the ankle replacement surgery, your surgeon will create an incision at the front of your ankle to expose the ankle joint. Carefully, the tendons, nerves, and blood vessels will be gently moved aside. Subsequently, the damaged bone and cartilage will be removed by your surgeon.
The affected portions that will be removed include:
- The lower part of your shin bone (tibia).
- The upper section of the foot bone (talus), which supports the leg bones.
Following this, the metal components of the new artificial joint will be attached to the cut bony surfaces. To secure them in place, a special adhesive or bone cement may be utilized. A plastic piece will be inserted between the two metal parts, and screws might be employed to stabilize the ankle.
The surgeon will then realign the tendons and suture the incision. Depending on your situation, you may be required to wear a splint, cast, or brace for a period to immobilize the ankle. It will be instructed that you refrain from putting weight on the leg until the implant has fully fused with the ankle, promoting healing.
Why is ankle replacement surgery performed?
Total ankle replacement surgery may be recommended when the ankle joint is severely damaged, resulting in symptoms such as pain and restricted movement. Various factors can contribute to this damage, including:
- Arthritis resulting from previous ankle injuries or surgeries.
- Fractures of the ankle bone.
- Infections affecting the ankle joint.
- Osteoarthritis is a degenerative condition that affects the joint cartilage.
- Osteonecrosis is a condition characterized by the death of bone tissue.
- Rheumatoid arthritis is an autoimmune disorder affecting the joints.
- Tumours affecting the ankle joint.
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Steps to be followed before, during and after the procedure
1. Before the procedure
In the two weeks leading up to your surgery, there are several important preparations to consider:
- Discontinue the use of medications that may affect blood clottings, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners (like Warfarin or Clopidogrel), and other similar drugs. Consult with your healthcare provider to determine which medications you should still take on the day of your surgery.
- If you have medical conditions like diabetes, heart disease, or any other relevant health concerns, your surgeon will likely advise you to visit the healthcare provider who treats you for these conditions. It is crucial to ensure your overall health is properly managed before the surgery.
- Inform your healthcare provider if you have been consuming excessive amounts of alcohol, exceeding one or two drinks per day. Openly discussing your alcohol intake will help them assess any potential risks or necessary precautions.
- Quit smoking, if you are a smoker, and seek assistance from your healthcare provider if needed. Smoking can impede the healing process of wounds and bones, and it significantly increases the likelihood of complications following surgery.
- Always inform your healthcare provider about any illnesses you may be experiencing, such as a cold, flu, fever, or herpes breakout, prior to your surgery. This information is vital for assessing your readiness for the procedure and ensuring appropriate precautions are taken.
- Consider visiting a physical therapist who can guide you through pre-surgery exercises. They can also provide instruction on the correct use of crutches if necessary, ensuring you are well-prepared physically for the upcoming surgery.
2. During the procedure
On the day of your surgery, please note the following guidelines:
- It is typically required that you abstain from consuming food or beverages for a period of 6 to 12 hours before the procedure. This fasting period helps to ensure your safety during anaesthesia and the surgical process.
- If you were instructed to take any medications on the day of your surgery, do so with a small sip of water unless otherwise specified by your healthcare provider. It is essential to follow their specific instructions regarding medication administration.
- Your healthcare provider will inform you about the designated arrival time at the hospital or surgical facility. It is important to adhere to their instructions to allow for necessary preparations and ensure a smooth transition into the surgical process.
3. After the procedure
After the surgery, it is likely that you will require a minimum one-night stay in the hospital. Depending on your specific situation, a nerve block may have been administered to manage pain during the initial 12 to 24 hours following the procedure.
Following surgery, your ankle will be placed in either a cast or a splint. To aid in the healing process, a small tube may be inserted to drain blood from the ankle joint, typically for a duration of 1 to 2 days. During the early stages of your recovery, it is important to prioritize reducing swelling by keeping your foot elevated above the level of your heart while sleeping or resting.
To facilitate your mobility, a physical therapist will guide you through exercises that promote easier movement. It is likely that you will be advised not to bear any weight on the ankle for several months as part of your recovery process.
Projected Outcome of ankle replacement surgery
A favourable ankle replacement outcome is expected to bring about the following changes:
- Reduction or elimination of pain in the ankle
- Restoration of the ability to flex and extend the ankle joint
- Typically, total ankle replacements have a lifespan of 10 years or more. The duration of your specific replacement will depend on factors such as your level of physical activity, overall health, and the extent of damage to your ankle joint prior to surgery.
Risks Involved
Ankle replacement surgery carries certain risks, which may include:
- Weakness, stiffness, or instability in the ankle.
- Potential loosening of the artificial joint as time passes.
- Delayed or inadequate healing of the surgical incision.
- Possible nerve damage.
- Potential damage to blood vessels.
- Risk of bone fracture during the surgical procedure.
- Potential dislocation of the artificial joint.
- Although extremely rare, there is a minimal chance of an allergic reaction to the artificial joint.
Conclusion
Total ankle replacement serves as a beneficial treatment choice for individuals suffering from advanced, end-stage ankle arthritis. It holds the potential to restore joint function, enabling patients to regain mobility with minimal or no pain. Nevertheless, it is important to consider several contraindications before proceeding with the procedure. Further research on the biomechanics of arthritic and replaced ankle joints, as well as long-term follow-up studies, is necessary to enhance our understanding of total ankle replacement outcomes.
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References:
- Barg, A., Wimmer, M. D., Wiewiorski, M., Wirtz, D. C., Pagenstert, G. I., & Valderrabano, V. (2015). Total ankle replacement: indications, implant designs, and results. Deutsches Ärzteblatt International, 112(11), 177.
- McBride, T. (2006). Ankle Replacement Surgery.
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