What to expect from an ankle replacement
Chronic ankle pain can significantly limit your mobility and affect your day-to-day life. For patients with advanced arthritis or severe joint damage, ankle replacement surgery may offer lasting relief and improved function.
In this article, consultant orthopaedic surgeon Mr Ali Abbasian outlines what to expect before, during and after ankle replacement surgery, and who may be a suitable candidate.
What is an ankle replacement?
An ankle replacement, also known as total ankle arthroplasty, is a surgical procedure in which a worn or damaged ankle joint is replaced with a prosthetic implant.
It is often recommended for patients with severe ankle arthritis who have not found relief through non-surgical treatments such as physiotherapy, injections or bracing.
Unlike ankle fusion (arthrodesis), which eliminates motion at the joint, ankle replacement aims to relieve pain while maintaining joint movement.
Modern ankle replacements are designed to closely replicate the movement of a natural ankle, offering selected patients the chance to return to daily activities with less pain and better mobility.
Who is a candidate for ankle replacement?
This procedure is usually considered for patients with:
- Advanced osteoarthritis, post-traumatic arthritis or rheumatoid arthritis of the ankle
- Low-to-moderate activity demands
- Reasonable bone quality and good alignment of the ankle and hindfoot
- No active infection or severe deformity
Younger patients or those with highly active lifestyles may be better suited to ankle fusion due to the wear that can occur on an artificial joint over time. Each case is assessed individually, taking into account lifestyle, X-rays, and overall joint condition.
The surgical procedure
Ankle replacement is performed under general or spinal anaesthesia. A small incision is made at the front of the ankle to access the joint. The damaged portions of the tibia (shinbone) and talus (ankle bone) are removed and metal and plastic components are inserted to form the new joint surface. The prosthesis is designed to allow smooth movement and mimic natural joint motion.
The procedure typically takes around 90 minutes, and most patients remain in hospital for 2 to 3 days.
Immediate post-operative period
After surgery, your ankle will be placed in a cast or boot to protect it while the soft tissues heal.
You will initially need to avoid putting weight on the leg, using crutches or a walker for support.
Swelling and discomfort are normal but well managed with medication and elevation.
Physiotherapy
A structured physiotherapy programme begins within the first 2 weeks. The focus is on:
- Gradually restoring range of motion
- Strengthening surrounding muscles
- Improving balance and gait
Most patients begin to bear weight on the ankle within 4 to 6 weeks, achieving good functional recovery within 3 to 6 months.
What are the benefits?
An ankle replacement can make a meaningful difference to quality of life, particularly for patients who wish to remain active in low-impact ways.
- Significant pain reduction
- Preservation of joint movement
- A more natural walking pattern compared to ankle fusion
- Reduced stress on nearby joints, like the knee and hip
Risks and considerations
As with any major surgery, there are potential risks. These may include:
- Infection
- Blood clots
- Implant loosening or wear
- Nerve or blood vessel injury
Over time, some ankle replacements may require revision surgery, particularly in younger or more active patients. Choosing an experienced surgeon and following rehabilitation advice can help minimise risks and improve outcomes.
Ankle replacement is a well-established and highly effective procedure for patients with severe ankle arthritis, offering pain relief while maintaining joint motion.
If you are struggling with chronic ankle pain and limited mobility, a consultation with Mr Abbasian via his Top Doctors profile can help determine whether ankle replacement is right for you.
