All you need to know about ankle replacement surgery

In this latest article, consultant orthopaedic surgeon Mr Billy Jowett shares all patients need to know about ankle replacement surgery.

What is the ankle?

The ankle is the joint that connects the foot to the leg. It is the junction point between the talus and the tibia and fibula, and is comprised of cartilage, ligaments, and muscles. The ankle mainly moves in two directions: downwards (plantar flexion), and upwards (dosiflexion). The ankle facilitates movements like walking, running, jumping, and dancing, and are used to help keep the body stable and balanced.

When does an ankle need replacement?

Ankles are susceptible to damage and dysfunction that can cause pain, stiffness, inflammation, or reduced mobility. This includes arthritis, gout, tendinitis, sprains, dislocations, fractures, and tendon injuries.

To treat ankle pathologies, some patients can benefit from taking pressure off the foot and resting it. However, sometimes the damage is so severe that the ankle will require replacement.

Typically, patients who are best suited to an ankle replacement are over 60 years old or post-traumatic and have advanced arthritis. The cartilage has to be worn down and significantly deteriorated for the patient to be recommended an ankle replacement.

What happens during an ankle replacement?

The procedure will address pain, deformity, and immobility of the ankle. The procedure involves shaving down the damaged ends of the tibia and talus bones and replacing them with prosthetic joint pieces that are made of metal which are secured with medical cement. Several approaches and techniques can be used during an ankle replacement, and there are two main types of replacement: a fixed bearing or a mobile bearing replacement.

A fixed bearing ankle replacement, the replacement component on the tibia is static, and the one on the talus slides up and down along it. This approach requires a high level of precision because it is susceptible to misalignment. In a mobile bearing replacement, the connective piece can move between both of the replacement components, meaning that it is more forgiving with the positioning and can easily be revised, but the components overall are more susceptible to wear and friction.

What is the recovery process after ankle replacement surgery?

After an ankle replacement, patients are usually in a boot for four to six weeks. Patients should start physical therapy after the second week, when their incisions have healed, starting with gait training  and they will progress to core muscle strengthening, range of movement exercises and calf stretches. At six weeks, patients can start walking without the boot – though they may have assistance with crutches – and doing things like swimming and driving. After six months, more physically demanding activities can be started again, like hiking.