Ankle replacement: what does it entail?

Total ankle replacement, also known as arthroplasty, serves as an essential surgical intervention for addressing severe arthritis within the ankle joint. This procedure entails the meticulous removal of deteriorated joint surfaces, subsequently replaced with metal prostheses separated by a polyethylene component. Ankle replacement stands as a pivotal treatment option alongside ankle fusion for individuals grappling with advanced arthritis in the ankle region.

Renowned consultant orthopaedic foot and ankle surgeon Mr Harron Majeed delivers the answers to your frequently asked questions about the surgery.

What are the benefits of ankle replacement?

The primary goal of ankle replacement surgery is to reduce pain levels and enhance overall function and quality of life for patients. Instead of opting for an ankle fusion, the replacement procedure aims to preserve the range of motion, which is essential for restoring a normal walking pattern.

The procedure

Total ankle replacement is a significant surgical procedure that may not be suitable for every patient or every ankle. The surgery is typically conducted under either general or spinal anaesthesia, often accompanied by a regional nerve block to ensure optimal post-operative pain relief.

Metal components are securely attached to the bones without the use of bone cement, leading to the ankle being placed in a temporary plaster cast. Patients typically stay in the hospital for around 2-3 days and undergo a comprehensive evaluation by a physiotherapist. Mobilisation with the assistance of crutches (or a walking frame) and toe-touch weight bearing is permitted.

Recovery

Following discharge from the hospital, it is advised to elevate the ankle and take pain medication during the initial days. Depending on the surgeon's preference, heparin injections may be administered for 6 weeks to reduce the risk of blood clots. The wound is located on the front of the ankle, and sutures are typically removed after 2 weeks. Dressings on the wound should not be disturbed until the 2-week clinic visit. At this point, the ankle will be placed in a walker boot, and weight-bearing will be gradually increased.

A follow-up clinic visit at 6 weeks will involve x-rays and transitioning out of the boot. Between weeks 6-12, you can gradually discontinue the use of crutches, return to normal footwear, and begin physiotherapy. Due to swelling, regular shoes may not fit well initially and may take several weeks to improve. A full recovery may take 3-6 months or longer in some cases.

Follow-up appointments are typically scheduled at 3, 6, and 12 months, followed by annual routine reviews and x-rays.

Complications after ankle replacement surgery

Following ankle replacement surgery, patients may encounter potential risks and complications, albeit in a small percentage of cases. These include:

• Infection.
• Wound problems.
• Bleeding.
• Formation of blood clots in the leg or lungs (deep vein thrombosis, pulmonary embolism).
• Fracture during or after surgery.
• Persistent pain and stiffness.
• Nerve and vessel damage.
• Numbness around the surgical scar.
• Chronic regional pain syndrome.
• Loosening of the implants.
• Long-term failure, requiring further surgery.
• Anaesthetic risks.

It is essential to note that the likelihood of experiencing these complications may escalate in the presence of specific medical conditions and the prolonged use of certain medications.

Longevity of the new ankle joint

Research indicates that a successful outcome of an ankle replacement procedure typically results in the preservation of optimal joint function in approximately 80-90% of cases at the 10-year post-surgery mark.

However, the longevity of the artificial joint is influenced by multiple factors. It is crucial to understand that ankle replacement procedures are not as established as hip or knee replacements and continue to evolve with the introduction of new implant designs in recent years. Consequently, the anticipated outcomes may not be as optimal as those seen with hip or knee joint replacements.

If you require ankle replacement and would like to book a consultation with Mr Majeed, you can do so via his Top Doctors profile today.