Ankle Replacement – Causes, Treatments, Surgery and Recovery
Ankle replacement is a type of surgery to replace a worn-out ankle joint. It’s generally used to treat arthritis which has been causing long term pain. Ankle replacement is a complex operation which is usually only carried out when other treatments haven’t worked.
If you’re considering ankle replacement surgery, this article guides you through the process, including treatment, recovery time, and success rates. It also addresses some of the most frequently asked questions about this procedure.
Total ankle replacement (TAR) is a surgical procedure to remove worn-out ankle joints and replace them with a new joint made of metal and plastic. The aim is to relieve the pain associated with an arthritic or injured joint, while maintaining motion.
Ankle replacement is an alternative option to ankle fusion, where the bones are permanently fused together. Ankle fusion is more common, but replacement has become increasingly popular over the last decade (1) thanks to advances in the design of prosthetic joints, which are having better long-term results. In 2010, the American College of Foot and Ankle Surgeons said the safety profile of ankle replacements had become comparable to ankle fusion.
The main reason for having an ankle replacement is arthritis. This is often caused by a previous trauma or injury like an ankle or talus fracture, dislocation, or multiple sprains. An injured joint is about seven times more likely than an uninjured joint to become arthritic.
It may also be the result of general wear and tear (osteoarthritis) in the ankle joint or a generalised inflammation of joints in the body (rheumatoid arthritis). Both types can cause pain in the ankle, but osteoarthritis is more common (2).
Ankle replacement surgery is usually a last resort when other treatments haven’t worked. If you have arthritis in your ankle, you’ll be encouraged to try non-surgical options first. They include: anti-inflammatory medicines, using a brace or cane, shoe inserts, cortisone injections, and physiotherapy.
If none of these have worked and the pain is affecting your daily life, it may be time to consider surgery. Ankle replacement isn’t for everyone so your doctor will look at your circumstances carefully to decide whether you’re a good candidate for surgery. It’s not usually suitable for people who are aged under 50 and are very physically active. If you’re overweight, have an unstable ankle, weakened ligaments, a previous infection, or nerve damage from another medical condition you may not be able to have this surgery either.
Total ankle replacement (TAR), also known as ankle arthroplasty, is carried out under general anaesthetic or nerve block. Your surgeon will make an incision at the front or side of your ankle to expose the joint and will then cut away the worn-out surfaces of your shinbone (tibia) and foot bone (talus), replacing them with a prosthetic joint made of metal and plastic. This will help the joint to move more freely.
If you’re not a good candidate for ankle replacement, your doctor may suggest ankle fusion, also known as ankle arthrodesis. In ankle fusion, metal plates and screws are used to fasten your damaged ankle bones together. This can help to relieve the pain caused by arthritis and may last longer than a replacement, but it will reduce mobility in your ankle.
Both procedures have pros and cons, the impact of which will depend on your individual circumstances, so it’s important to discuss the best option with your doctor. Ankle fusion is more common and can provide reliable, long-term pain relief. It’s usually recommended for younger people with more active lifestyles because it tends to last longer and is less restrictive. However, it reduces motion in the ankle joint and this can sometimes lead to increased stress on the surrounding joints, causing further arthritis problems over time.
Ankle replacement surgery is less common but, thanks to advances in medical technology, it’s becoming more popular. It tends to have more risks associated with it as the parts may wear out, loosen or break, which means you may need further surgery to correct the problem or convert to an ankle fusion. It also has more long-term restrictions on the type of activities you can do (no marathon running any time soon!). But if it’s successful, it can provide more mobility and protect the joints around your ankle from becoming arthritic.
A 2019 medical study(3) compared patients who had an ankle replacement with those who went for ankle fusion and found that there were no significant differences in outcome. Both groups reported an improvement in joint function, pain relief and quality of life.
Your doctor will advise you about what you need to do before surgery. Make sure you tell them about any medication that you’re taking, even over the counter ones. You may be advised to stop taking certain drugs that make it harder for your blood to clot (common ones include aspirin or Warfarin). Try to stop smoking before the operation because this can increase your risk of complications from the surgery and slow down the healing process.
You’ll need to avoid any food or drink for 6-12 hours before your procedure – your doctor will tell you when the cut off time is, depending on when your surgery is scheduled. You may have X-rays, a CT or MRI scan before surgery.
After surgery your leg will be numb and you may feel some discomfort, but you’ll be given pain relief to help with this. Your incision will be covered by a dressing and you’ll need to wear a splint or cast which protects your ankle while it heals.
The amount of time spent in hospital varies between patients but it’s likely to be between 1-3 days. You’ll be discharged when your doctor is content that your pain is under control and that you can get around safely with crutches. At home, continue taking the pain medication that you’ve been prescribed and keep your leg elevated where possible to reduce swelling and encourage the wound to heal.
You won’t be able to put any weight on your ankle for up to six weeks after an ankle replacement. During this time, you’ll need to use crutches or a mobility device like a knee scooter or hands-free crutch to help you get around.
A long period of non-weight bearing can often be the worst part of surgery. Traditional crutches are frustrating to use and can be painful and exhausting to get around on. Luckily these days there are more options available to help you stay mobile and active. The most popular are a knee scooter and the iWALK hands-free crutch.
Here are the main features of each one:
Crutches are the most common mobility device and are used by millions of people worldwide each year. In the US underarm crutches are more popular, whereas in Europe you’re more likely to see people using elbow crutches. Both types are relatively cheap and easy to get hold of and can be a useful quick fix to help you get about.
However, crutches are stressful. They’re frustrating because you lose the use of your hands and arms as well as your injured leg, which makes carrying anything or doing day to day chores pretty much impossible. They are also exhausting to use, which means you can’t go far on them and they can cause further pain in your back, shoulders, arms, and hands. That’s why more and more people are choosing to use an alternative mobility device.
A knee scooter is a three or four wheeled non-motorised device which allows you to scoot around with your injured leg resting safely on a special padded platform. You use your other leg to propel yourself and it makes getting from A to B a lot easier, quicker, and less exhausting than crutches.
Knee scooters are a good option for getting around on flat surfaces. However, they can’t be used on uneven surfaces or stairs, and they are quite bulky which makes it tricky to get them in and out of cars etc.
The iWALK is a hands-free crutch. It functions just like a prosthetic leg, enabling you to walk around freely, unaided, and have full use of your hands and arms. Your injured leg rests on a padded platform, keeping it safely protected the whole time.
If you’re dreading the idea of being housebound for weeks, the iWALK crutch could be a great option for you. It enables you to live – and enjoy – your daily life while you recover, whether that’s grocery shopping, pushing a pram, walking the dog, doing the school run, going to work or even visiting the gym. It can be used on uneven ground and stairs too.
While you recover, it’s important that you keep your wound clean and dry so remember to cover your leg with a special protective cover while showering or bathing. If you don’t have one of these, the next best thing is a well secured plastic bag. Sit on a bench or chair or use a hands-free crutch in the shower to protect yourself from any slips or falls.
After your non-weight bearing period, you’ll slowly be able to start putting weight on your ankle again. You’ll need physiotherapy to strengthen the joint and increase your range of motion and it’s likely that you’ll continue to wear a boot for a few more weeks.
It can take up to a year to fully recover from ankle replacement surgery and get back to normal life. You’ll probably be advised to avoid high-impact activities like running or contact sports but things like swimming, walking and cycling are usually fine. Talk to your doctor if you have any concerns at all.
Most ankle replacements last 10 years or more. How long yours lasts will depend on a number of things, including how damaged your ankle joint was to begin with, how successful the surgery was, your activity levels, and your overall health.
New technology is improving the success rate of ankle replacement surgery. Studies have documented(4) success rates of 90% 10 years post-surgery. Swedish research(5) found that 71% of patients were either satisfied or very satisfied 24 months after their surgery, and 12% were dissatisfied or very dissatisfied.
You won’t be able to put any weight on your ankle for up to six weeks after surgery. Once you’ve got the green light from your doctor, you can start slowly bearing weight but it’s likely to be a few more weeks before you’re fully walking again.
People recover at different speeds so go at the pace that your doctor has advised is right for you. Physiotherapy can help during this time so make sure you do any exercises given to you by your therapist or doctor. It can take up to a year before you’re fully recovered.
The ankle joint is where your tibia (shinbone) and talus (the bone of your foot) meet. During ankle replacement, the surgeon will remove the damaged bits of these joints and replace them with a new prosthetic joint made of metal and plastic.
Research shows that 90% of artificial ankles are still functioning well 10 years after surgery. But they can loosen or wear out over time and if this happens you may need either a revision surgery or a conversion to an ankle fusion.
The total cost of an ankle replacement can be around $40,000. This surgery is usually covered by health insurers although there have been reports of companies refusing to pay for it in the past because they consider it an experimental procedure. There may be certain criteria that you need to meet in order for your insurer to cover it.
The surgery usually takes two to two and a half hours.
Arthritis in the ankle joint is often caused by a previous injury, like a broken ankle, but it can also be a result of osteoarthritis or rheumatoid arthritis. The main symptoms are swelling, pain, stiffness, and reduced ability to walk. If you have arthritis in your ankle, you’ll be encouraged to try non-surgical treatment first. This may include:
• Wearing shoe inserts (orthotics) or custom-made shoes
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Using a cane or wearing a brace
• Physiotherapy to help increase range of motion and flexibility
• Cortisone injections
The aim of non-surgical treatment is to reduce the symptoms of arthritis in your ankle. However, if these aren’t working and your symptoms are affecting your daily activity, surgery may be recommended to remove part of the arthritic joint. Your doctor will assess your case individually to determine whether total ankle replacement or ankle fusion is right for you.
End stage ankle arthritis is when the surface of the ankle joint has been progressively worn down, causing pain, loss of function and mobility, and severely limiting daily activity. If you’re diagnosed with end stage ankle arthritis, and non-surgical treatments haven’t helped, you may be advised to consider surgery.
|The information above is intended for informational purposes only and is not intended to prevent, treat, or diagnose any illness or disease. We aim to provide the highest quality information, so if you have any questions on the information above, we welcome your feedback!|