Total Ankle Replacemnet

What is total ankle Replacement?

Total ankle Replacement is very useful procedure for patients with end stage arthritis of the ankle joint. Arthritis of the ankle is a most commonly secondary to severe fractures and dislocation but also occurs as a result of wear and tear. Arthritis eventually leads to loss of cartilage, pain and/or deformity. The aim of ankle replacement is to improve ankle motion so the patient has less pain during activity.

When Total Ankle Replacement is needed?

TAR is considered in patients that suffer significant ankle pain and decreased function from arthritis after trying non operative management. Rheumatoid arthritis patients are usually good candidates for the ankle joint replacement. Other patients that should be considered are those that need but do not want a fusion-type procedure that would eliminate the motion at the ankle joint.

When should I avoid TAR?

TAR should be avoided in the presence of significant deformity or dead bone in the talus. It also not suitable in patients with previous or current infections of the ankle, neuropathy, inadequate leg muscle function, poor blood flow of the leg, or inadequate soft tissues.

What does the surgery entails?

The ankle is approached from the front with a tourniquet around the thigh. Bone is then cut using special cutting jigs, allowing for insertion of the metal and plastic components that re-create the ankle joint. Sometimes a tight Achilles tendon has to be lengthened to improve range of motion of the ankle. The wounds are then closed using stitches or staples, and a splint is applied. A period of protected weight-bearing in either a cast or boot is necessary to allow the soft tissue and implants to heal in place.

What happens after surgery?

Recovery from a total ankle replacement requires a period of immobilization in a cast or a boot. Patients usually spend few nights in the hospital. Elevation is advised to control swelling and improve wound healing. After the surgical wounds are healed, the patient is allowed walking using a boot or a cast. The cast or boot is usually removed after 4-6 weeks.

What are the potential complications?

General complications include the risks associated with anaesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Fracture of bone on the side of the ankle is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication. Wound healing can be a problem in smokers and diabetic patients in addition to patients that have rheumatoid arthritis.

Which is better ankle fusion or total ankle replacement?

Each case has to be assessed individually and the treating surgeon will recommend the best treatment that suits your case. In general, when motion of the ankle is preserved in a TAR, the surrounding joints are protected from increased wear. This helps preserve the surrounding joints from arthritis. Long term studies have shown that patients with ankle fusions usually develop progressive arthritis in the surrounding joints in about 10 to 15 years.

The number of ankle replacements being performed is increasing dramatically. This is a result of improved outcomes. Newer implant designs and improved surgical techniques are helping patients be more active after a TAR than they were previously.