Ankle Joint Replacement
What is Ankle Arthritis?
The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia and fibula, with the talus, or ankle bone.
The surface of the ankle bones is covered with an articular cartilage. Damage to this cartilage leads to a condition called an arthritic ankle, which results in pain and impaired movement of the ankle.
Ankle arthritis is unique when compared to hip and knee arthritis. While hip and knee arthritis is most often from “wear and tear” degeneration, ankle arthritis is most often the result of a previous injury to the ankle. Other causes of ankle arthritis include infection, connective tissue disorder, excessive stress, and certain disease conditions such as rheumatoid arthritis.
How is Ankle Arthritis Diagnosed?
Ankle arthritis is diagnosed by your physician after taking a history and performing an examination of the symptomatic ankle. Imaging such as X-ray, CAT Scan and MRI may be ordered to confirm the diagnosis.
What are the Treatment Options for Ankle Arthritis?
Conservative treatment of ankle arthritis involves oral medications and joint injections. However, for patients who are unresponsive to conservative treatment, surgery may be recommended. Certain patients are candidates for an ankle joint replacement instead of ankle fusion.
What is Ankle Joint Replacement Surgery?
Ankle joint replacement, also known as total ankle arthroplasty, is a surgical procedure performed to relieve pain and immobility due to severe end stage arthritis that has not responded to non-surgical treatments. The goal of ankle joint replacement surgery is to eliminate your pain and increase the mobility of your ankle joint.
Ankle joint replacement may also be recommended for elderly patients with a severe fracture from osteoporosis, or presence of a tumor in the ankle joint.
How is an Ankle Joint Replacement Performed?
Ankle joint replacement surgery is performed under general anesthesia. and often with the use of a nerve block. Your surgeon makes an incision over the front of the ankle. The muscles are retracted and tendons and ligaments are moved away to expose the ankle joint. The damaged part of the tibia, fibula, and talus bone are then removed using special instruments, and the remaining part of the bones are reshaped to fit the new artificial joint or prosthesis. While older implants utilized bone cement to hold the device in place, newer implants have specially designed surfaces to allow the bone to grow into the implant.
at the end of the surgery, tendons and other structures are placed back in position covering the new joint and the wound is sutured closed and covered with a sterile dressing.
What is the Postoperative Care for an Ankle Joint Replacement?
Following ankle joint replacement, the patient may need to stay in the hospital for 2-3 days and will be advised on precautions for a successful recovery.
The treated ankle will be immobilized with the help of splints and a bulky dressing. Patients are advised not to put any weight on the until advised it is safe to do so. In many cases, patients can begin putting full weight on the ankle in as little as one week. Swelling and discomfort can be managed by taking prescription pain medicines, applying ice packs, and by elevating the ankle above heart level while resting. You will be referred to physical therapy soon after surgery to regain range of motion of the new ankle. Sutures are removed after 10-15 days and you should take care that the incision is kept clean and dry. Patients should avoid smoking, alcohol consumption, and should eat a healthy diet for the best outcome.
What are the Risks and Complications of Ankle Joint Replacement?
As with any major surgery, there are potential risks involved. The possible complications associated with ankle joint replacement include infection, fracture of the tibia or fibula bone, dislocation of the ankle, damage to nerves or blood vessels, blood clots (DVT or Deep Venous Thrombosis), loosening of artificial components, failure to relieve pain, instability and stiffness.
What’s new in Ankle Joint Replacement?
Ankle replacement designs have improved over the years that they have been available. While early implants were prone to early failure with catastrophic outcomes, the newest generation of implants are expected to provide durable pain relief lasting on the upwards of 20 years.
Some of the newer implants utilize CAT scan to create 3-D models of the bones in the ankle along with cutting guides to improve the accuracy of implant alignment, and decrease the surgical time.
Most recently, revision systems have been created for cases of failed ankle joint replacement. In the past, failed ankle joint replacement had catastrophic complications. These new revision systems allow for the ankle joint replacement to be revised with another implant preserving motion and improving pain.