Although non-surgical (conservative) treatments such as physiotherapy and activity modification can often relieve the pain and stiffness caused by arthritis of the ankle, some patients are not able to find an effective way to resolve their symptoms. In such cases, surgery to replace the ankle joint may be considered. In this expert guide to ankle replacement surgery, highly respected London consultant orthopaedic surgeon Mr Andrew Goldberg, who specialises in foot and ankle surgery, details how the procedure is performed, what to expect from recovery after surgery and beyond. Mr Goldberg also explains how arthritis affects the ankle joint and when surgery is necessary in this in-depth article, the first in this series on ankle replacement surgery.
What does ankle replacement surgery involve?
Total ankle replacement surgery is an operation to replace a worn-out ankle joint. This is done by resurfacing the ends of your tibia (shin bone) and talus (ankle bone) with metal components and then inserting a plastic liner between them which allows for a gliding motion.
A lot of planning goes into having an ankle replacement. Firstly, your surgeon will check that you are eligible. If your surgeon uses the latest, state-of-the-art techniques called patient specific instrumentation (PSI) then they will order a set of special scans to enable a plan of your surgery to be created, which is a little like an architect’s drawings before a house is built. The surgeon meets with you and goes over the plans and reconfirms your eligibility before a date for surgery is made. This type of surgery is carried out under general anaesthetic.
The surgeon makes a small incision at the front of the ankle to replace the damaged surfaces. Sometimes damaged or torn ligaments also need repairing at the time of the surgery. The surgery usually takes about ninety minutes from start to finish. Afterwards, you will be in a below-knee plaster for 2 to 4 weeks, depending on how long the skin incision takes to heal.
What causes arthritis of the ankle?
Ankle arthritis occurs when the shock absorbing cartilage in the ankle joint becomes worn, meaning that bones rub against bones. This causes pain and stiffness in the joint - the two main symptoms of arthritis.
Most cases of ankle arthritis are caused by an injury, such as a broken ankle, or recurrent severe ankle sprains. Some cases are related to rheumatoid arthritis or another form of auto-immune arthritis where the body attacks itself such as gout or pseudogout. Rarely, arthritis of the ankle follows infection or bleeds into the ankle (which may be related to haemophilia).
When is ankle replacement necessary?
Most patients with ankle arthritis respond to non-surgical treatments. Therefore, surgery should usually only be considered on failure of non-surgical treatments such as physiotherapy, ankle supports, activity modification, pain killers and weight loss. If these treatments have been tried and failed, ankle replacement surgery can be considered.
What types of results can be expected following ankle replacement surgery?
In my own practice, I use the Infinity Implant (made by Stryker Inc), which is the most commonly used type of ankle implant in the world. I additionally use patient-specific instruments, meaning the implant is designed to your anatomy and unique circumstances.
Usually, patients enjoy an improved range of motion of the joint following an ankle replacement. However, this is not always the case and patients can sometimes have issues caused by stiffness and scarring of the soft tissues. In order to maintain realistic expectations about the outcomes of your surgery, you should discuss the most likely results in terms of range of movement in your individual case with your surgeon.
How long does it take to recover from ankle replacement surgery?
It takes 6 weeks to recover from the initial surgery but up to 6 months before you can return to more vigorous activities. In most cases, walking will be normal, so that others may not notice that you have had an ankle replacement. If, prior to surgery, you walked with a limp or experienced discomfort while walking, this is likely to improve following the operation.
Following ankle replacement surgery, nearly all patients are able to go back to partaking in long walks, hiking, cycling and leisurely sports, such as golf. More vigorous activities, such as squash, tennis or jogging, put a lot of stress on the ankle and can cause the prosthesis to wear or fail more quickly. Therefore, although some patients do return to these sports, we do not recommend doing so following an ankle replacement.
Mr Goldberg is renowned for his expertise in the treatment of orthopaedic conditions affecting the foot and ankle and excellent patient care. You can schedule an appointment with Mr Goldberg to further discuss concerns or questions you may have about arthritis of the ankle or ankle replacement surgery by visiting his Top Doctors profile.