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Ankle replacement (total)

Total ankle replacementWhat is arthritis?

Arthritis is a group of conditions that cause damage to one or more joints.

The most common type of arthritis is osteoarthritis, where there is gradual wear and tear of a joint. Some other types of arthritis are associated with inflammation of the joints.

Arthritis eventually wears away the normal cartilage covering the surface of the joint and the bone underneath becomes damaged. This causes pain and stiffness in the joint.

What are the benefits of surgery?

If your ankle replacement is successful, you should have less pain and be able to walk more easily.

Are there any alternatives to ankle replacement?

Simple painkillers such as paracetamol and anti-inflammatory painkillers such as ibuprofen can help control the pain. Supplements to your diet may also help relieve your symptoms. You should check with your doctor before you take supplements.

Using a walking stick can make walking easier. A plastic splint or stiff ankle boot with a cushioned heel is sometimes helpful.

Regular moderate exercise can help to reduce stiffness in your ankle.

A steroid injection into your ankle joint can sometimes reduce pain and stiffness.

A keyhole operation (arthroscopy) to clean out the ankle joint can give some relief for six to twelve months.

All these measures become less effective if your arthritis gets worse.

For young and active people it is often better to have an ankle arthrodesis where the ankle bones are permanently fixed together using screws. This also results in less pain from arthritis and almost normal walking.

What does the operation involve?

A variety of anaesthetic techniques is possible. The operation usually takes between an hour and an hour and a half.

Your surgeon will remove the damaged joint surfaces and replace these with an artificial joint made of metal and plastic (see figure 1).

The ankle replacement is fixed to the bone using special coatings on the metal that bond directly to the bone.

What complications can happen?

General complications

  • Pain
  • Bleeding
  • Infection of the surgical site (wound)
  • Unsightly scarring
  • Blood clots
  • Difficulty passing urine
  • Chest infection
  • Heart attack
  • Stroke

Specific complications

  • Damage to nerves
  • Damage to blood vessels
  • Slow healing of the wound
  • Fracture
  • Infection in the ankle
  • Failure of the ankle replacement
  • Continued discomfort
  • Severe pain, stiffness and loss of use of the foot and ankle (complex regional pain syndrome)

How soon will I recover?

You should be able to go home after two to five days.

To start with, you should spend most of the time with your leg raised on a chair or footstool. You will need to use crutches or walking sticks for a few weeks.

Once the plaster cast is removed, regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Most people make a good recovery, have less pain, and can move about better. An artificial ankle never feels quite the same as a normal ankle, and it is important to look after it in the long term.

An ankle replacement can wear out with time.

Summary

Arthritis of the ankle is often the result of previous ankle injuries or rheumatoid arthritis. If you suffer severe pain, stiffness and disability, an ankle replacement should reduce your pain and still give you some movement in your ankle.

Acknowledgements

Author: Mr Stephen Milner DM FRCS (Tr. & Orth.)

Illustrations: Medical Illustration Copyright © Medical-Artist.com

Copyright © 2016 EIDO Healthcare Limited - The operation and treatment information on this webpage is produced using information from EIDO Healthcare Ltd and is licensed by the Horder Centre.

The intellectual property rights to the information belong exclusively to EIDO Healthcare Limited. You may not copy, print out, download or otherwise reproduce any of the information other than for your personal, non-commercial use. The information should not replace any advice that your relevant health professional would give you.

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