What is ankle replacement surgery?
Ankle replacement surgery involves a total replacement of the ankle joint that connects the tibia (shin) to the talus (ankle bone). The natural joint is replaced with a prosthetic joint to restore foot mobility and reduce pain.
There is a wide range of prosthetic ankle joints available and prosthetic technology has advanced significantly in the past 30 years.
Why is it done?
Ankle replacement surgery is typically performed on patients whose ankle joint has been severely affected by osteoarthritis. Generally, it is recommended as an option when other approaches, such as pain medication, shoe inserts or physical therapy, haven’t worked to control symptoms of pain and discomfort.
The main reasons patients undergo this surgery are due to:
Most patients that undergo this procedure are over the age of 60, but it is sometimes offered to younger patients depending on their condition.
What does ankle replacement surgery consist of?
The procedure consists of making a 15cm long incision over the front of the ankle and then cutting away or removing the damaged bone and joint. They will then insert a new artificial joint and connect it to the newly cut down bone. The surgeon puts the tendons and muscles back into place and sews up the incision. The entire operation can last up to an hour and a half.
Ankle replacement surgery is usually performed under general anaesthesia but in some cases, a local anaesthetic may be used so that you can eat and drink immediately afterwards and leave the hospital sooner.
How to prepare for surgery
You will likely have a checkup a few weeks before the procedure to make sure you are healthy enough to undergo surgery. A physical therapist may also check to see how well your ankle works so you can compare it after surgery.
You may be asked to stop taking certain medications, such as blood thinners, a few days before the procedure.
On the day of the procedure, you will first meet with an anaesthetist to review your anaesthesia options or other types of sedatives.
After the operation
You will likely spend up to three days in hospital after the operation, with your leg elevated until the swelling subsides. Once the swelling is gone, a cast will be placed on your leg and you will be shown how to walk using crutches.
Depending on the hospital and how quickly you recover, your ankle may be in a cast for 3-6 weeks. During this time you can have checkups with a nurse, who will remove the cast, inspect the incision wounds and apply a new cast.
After a few weeks, you will need to visit the hospital again to have an X-ray so the doctor can check your ankle has completely healed. Once the doctor is confident that your ankle has healed corrected, the cast will be removed and you’ll be able to walk without crutches. You must receive continuous physiotherapy for a while afterwards to help mobilise the ankle.
During the first few days, you may experience some moderate pain but this can be controlled with appropriate pain-relieving medication.
During the first two weeks after the operation, you must not apply any weight on the foot. You very likely won't be able to go to work for up to 6 weeks and you won't be able to drive until you can make perform an emergency stop without experiencing pain in the foot.
Once the cast is removed you can begin to increase your level of exercise; walking and swimming are the best during your recovery. Your doctor will likely advise you not to participate in high impact sports such as rugby or tennis.
Alternative treatments to ankle replacement surgery
Ankle surgery is not recommended in patients with:
- A collapsed talus (ankle bone)
- Loss of sensation in the feet due to diabetes
- Poor circulation in the legs
- Severe ankle deformity
- Ligament instability
In these cases, an ankle fusion might be recommended instead.