Total Ankle Joint Replacement (ankle arthroplasty)
Ankle joint replacement involves removing both sides of the ankle joint and replacing them with specifically designed synthetic parts. The one that fits on the end of the tibia is made of a medical alloy covered with a long lasting medical grade plastic. The other is made of medical alloy and fits on top of the talus and slides against the tibia. These parts come in varies sizes in order to give the proper fit.
The surgery takes a few hours and the patient will either be given a spinal anesthetic and a little something to help you relax or a general anesthesia which will put you to sleep.
Ankle Fusion
When performing an ankle fusion, the surgeon removes the damaged bone and cartilage between the tibia and talus bones and then fuses the two together using screws, plates and bone cement. When necessary a rod may also be used to help strengthen the joint as well. Mobility with an ankle fusion is never fully regained but the pain and discomfort is improved dramatically.
Recovery
After surgery, the hospital stay will be for approximately 3-5 days depending on the support system the patient has at home. The foot will be in a cast for 4 to 6 weeks to protect the new ankle to keep it in the exact position and allow the bone to grow around the metal and cement. During this time the patient will use a walker or crutches and be able to do a little weight bearing. Gradually over the next few months with the help of a physiotherapist the ankle and surrounding muscles will become strong enough for full weight bearing. Rehabilitation exercises, once the stitches have been removed and the incision has healed include bicycle and swimming therapy. Although it takes the ankle about a year to heal completely the patient should be able to return to their normal lifestyle within six months.
Risks Before, During & After Surgery
- Poor circulation in the leg
- Patients with diabetes
- Patients with nerve conditions of the leg
- Poor bone quality of the ankle possibly causing bone breaking during surgery
- Allergic reactions to medicines
- Breathing problems
- Blood clot infection
- Loosening of the artificial joint over time
- Ankle weakness, stiffness, instability dislocation of the synthetic ankle
- Incision/ankle infection if severe may need the ankle amputated
- Joint allergic reaction to the synthetic joint
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Which one is right for you?
The weighing in factors are your pre-surgery health, your lifestyle and your expectations after surgery. Ankle replacement does provide more normal movement, but the life span of the joint is only between 8-12 years and then the joint will need to be replaced again or fused depending on the damage done. Ankle fusion is permanent and does limit the range of motion. However it does add stress to other ankle/foot joints which in return may also need to be fused. The choice of total ankle replacement or ankle fusion or no surgery is a serious and complicated one. Be sure to discuss with your rheumatologist and orthopedic surgeon any concerns or questions you have.
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