Ankle Replacement Surgery

What is ankle replacement surgery?

Ankle replacement surgery is the replacement of a damaged ankle joint with an artificial implant.

The ankle joint (tibiotalar joint) is where your shinbone (tibia) rests on top of a bone of your foot, the talus.

Arthritis can affect this joint as well as other joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This can result in pain, inflammation, and swelling of your joint.

Ankle replacement surgery is a procedure to replace this damaged joint to eliminate this pain and swelling. Typically, the procedure takes place under general anesthesia. Your surgeon will make an incision in your ankle to access the affected joint. Next, your surgeon will remove the damaged parts of your tibia and talus bones. Your surgeon will attach artificial metal joints to the remaining bone surfaces, with a piece of plastic inserted between them.

Why might I need ankle replacement surgery?

Ankle replacement surgery may make sense for you if you have severe arthritis in your ankle. This can cause symptoms like severe pain, inflammation, and stiffness, which can lead to difficulty walking. The main types of ankle arthritis are:

  • Osteoarthritis (“wear and tear” arthritis that develops in older adults)
  • Rheumatoid arthritis (a system-wide immune disease that affects the joints)
  • Arthritis due to previous injury of your joint

If you have mild or moderate arthritis, your doctor will probably recommend other treatments, like pain medications, special shoe and foot inserts, physical therapy, or corticosteroid injections. If you still have severe symptoms that interfere with your daily activities, your doctor may recommend ankle replacement or another surgical procedure.

If your arthritis is not yet severe, arthroscopic debridement might be a better option. Ankle fusion is another option for people with severe arthritis of their ankle. Each of these options has its own risks and benefits. Talk to your doctor about all of your treatment and surgical options.

What are the risks for ankle replacement surgery?

Ankle replacement surgery is very successful in most cases, but it does have some risks. These include:

  • Infection
  • Damage to nearby nerves
  • Bleeding
  • Blood clot
  • The bones not joining together properly
  • Misalignment of the bones
  • New arthritis in neighboring joints
  • Loosening of the artificial components, which might eventually require a follow-up surgery
  • Wearing out of the components

Your own risk of complications may vary according to your age and your other medical conditions. For example, if you are a smoker or if you have low bone density, you may have an increased risk of certain complications. People with poorly controlled diabetes may also have an increased risk. Talk with your doctor about all your concerns, including the risks most relevant to you.

How do I prepare for ankle replacement surgery?

Talk with your doctor about what to do to prepare for your ankle fusion surgery. Ask whether you should stop taking any medications, like blood thinners, ahead of time. If you smoke, try to stop smoking before your procedure. Tell your doctor about all the medications you take, including over-the-counter medications like aspirin. Also, tell your doctor about any changes in your overall health, such as a recent fever.

Before your procedure, you may need additional imaging tests, like X-rays or magnetic resonance imaging (MRI).

You may need to rearrange your living arrangements as you recover, because you’ll need to use crutches for several weeks. Have someone available to drive you home from the hospital.

You’ll need to avoid food and drink after midnight the night before your procedure.

What happens during ankle replacement surgery?

Your doctor can help explain the details of your particular surgery. An orthopedic surgeon and a team of specialized health care professionals will perform your ankle replacement. The whole operation may take a few hours. In general, you can expect the following:

  • You will probably have general anesthesia, which will make you sleep so that you feel no pain or discomfort during the procedure.
  • A health care professionalwill carefully monitor your vital signs, like your heart rate and blood pressure, during the operation.
  • After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your ankle, and possibly another one on your foot.
  • Your surgeon will remove the damaged portions of your shinbone and talus.
  • Next, your surgeon will attach the new metal joint surfaces into the pieces of your remaining bones. Your surgeon might use a special type of cement to hold them in place.
  • Your surgeon will also probably insert a piece of plastic between the new metal joint spaces, so they can glide easily against each other.
  • Your doctor may make other necessary repairs.
  • Your surgeon will surgically close the layers of skin and muscle around your ankle and foot.

What happens after ankle replacement surgery?

Talk with your doctor about what you can expect after your surgery. Your medical team will continue to monitor you carefully as you recover. When you wake up, your leg will probably be immobilized and elevated. You can resume a normal diet as soon as you are able. You may need follow-up X-rays to see how your surgery went. You will probably need to stay a few days at the hospital.

You may have significant pain right after your surgery, but you can have pain medications to help ease the pain. The pain should begin to diminish over the next few days, and you should have less pain than before your surgery.

After your surgery, you will probably need to wear a splint for a couple of weeks. You might also need to use crutches for several weeks. Your doctor will give you instructions about how to move your foot while you recover. It may be helpful to rest and elevate your leg for the first week or so after your surgery. You won’t be able to put your full weight on your foot for a few months.

You won’t be able to see your incision, but let your doctor know right away if the pain increases or if you have a high fever.

Make sure to keep all your follow-up appointments, so that your doctor can monitor your progress. You may have your splint removed and replaced with a cast a couple of weeks after your surgery. This cast may come off about 12 weeks after your surgery. You might need physical therapy for a few months to help you maintain your strength and range of motion. It may be several months before you can return to all your previous activities.

Carefully following your doctor’s instructions about rehabilitation, medications, and wound care should increase your chances of a positive outcome.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure

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