Ankle replacement surgery: An expert's guide

In his latest online article, Mr Harron Majeed gives us an insight into his experience with ankle replacement surgery. In this article he talks us through when ankle replacement surgery is required, who are the most suitable candidates, how the surgery is performed, the risks involved, and how long recovery can take.

When is ankle replacement surgery required?

Ankle replacement surgery is one of the two definitive surgical options for managing the symptoms of end stage ankle arthritis. The first line treatments are all non-surgical, including pain relief, shoe wear modifications and activity advice. If someone is struggling with the end stage arthritis with intractable symptoms which are not controlled with other methods, then ankle replacement is one of the options that is employed.

Who is the most suitable candidate and who might be not suitable?

Ankle replacement is not for everyone. The most suitable candidate, is someone of the minimum age of 55 years, who takes part in relatively low demand activities. For example, if you are a builder, a heavy mechanical worker or a sports person, ankle replacement does not suit this these types of people. There has to be no history of any previous neurological or vascular problems or infection in that joint. Generally, someone who can look after the joint well in the future.

How is ankle replacement surgery performed?

Ankle replacement surgery is a major operation. The incision, the cut is on the front of the ankle, which usually heals in a couple of weeks’ time. I will make cuts on the rough surfaces of the joints in a very specialised manner. Every step is followed by certain principles and using certain instruments. Once prepared, I then insert the artificial implants, which are the metal implants on the bones and the highly specialised plastic or polyethylene in between. The overall operation takes about two to three hours.

 How long does recovery take?

The overall recovery may take six to 12 months. However, the majority of individuals recover reasonably well within about six months. In artificial joints, it is a well-known fact that the recovery may continue to progress for longer than expected.

What are the risks involved?

There are certain risks involved with it being a major operation, other risks include wound healing problems, infection down deeper in the joint, blood clots in the legs or lungs and fractures that can happen around the artificial joints. Implants are not for life. They may start to become loose at a certain time in their lifetime and may require revision operations in the future. Certain nerves, vessels or tendons are at risk, but we take utmost precautions to minimise their damage during surgery. Pain may still continue despite a good operation because foot and ankle is a complex joint and there are other reasons for pain in the surrounding region as well. Overall, it's a good operation in good hands for suitably selected patients for all the right indications.

What can I do after ankle replacement surgery?

Ankle replacement surgery is not for someone who is a sports person or a heavy builder or someone who likes to enjoy heavy impact loading activities because artificial joints are not a replacement for the natural joints. They are designed in a way that the person can have a pain free joint with a good quality of life, but there are certain limitations. The more the person looks after these joints by minimising their heavy impact activities, the longer the life of that joint.

Mr Haroon Majeed is a highly regarded consultant orthopaedic foot and ankle surgeon with over 10 years of experience in his field. To schedule an appointment with Mr Majeed you can on his Top Doctors profile.