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Ankle replacement
Definition
Ankle replacement is surgery to replace the damaged bone in the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. They come in 4 different types of ankle replacement done in the United States.
Alternative Names
Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery
Description
Ankle replacement surgery is most often done while you are under general anesthesia. This means you will be asleep and pain-free.
You may have spinal anesthesia. You will be awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be given medicine to help you relax during the operation.
Your surgeon will make a surgical cut in the front of your ankle to expose the ankle joint. Your surgeon will then gently push the tendons, nerves, and blood vessels to the side. After this:
- Your surgeon will remove the damaged bone and cartilage.
- Your surgeon will replace the damaged part of :
- The lower end of your shin bone (tibia)
- The top of your foot bone (talus) that the leg bones rest on
- The metal parts of the new artificial joint are then attached to the cut bony surfaces. A special glue/bone cement may be used to hold them in place.
- A piece of plastic is inserted between the two metal parts.
After putting the tendons back into place, the surgeon closes the wound with sutures (stitches). You may need to wear a splint, cast, or brace for a while to keep the ankle from moving.
Why the Procedure Is Performed
Ankle replacement surgery may be done if the ankle joint is severely damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:
- Arthritis caused by ankle surgery in the past
- Bone fracture
- Infection
- Osteoarthritis
- Rheumatoid arthritis
You may not be able to have a total ankle replacement if you have had ankle joint infections in the past.
Risks
Risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery are:
- Bleeding
- Blood clot
- Infection
Risks for ankle replacement surgery are:
- Ankle weakness, stiffness, or instability
- Loosening of the artificial joint over time
- Skin not healing after surgery
- Nerve damage
- Blood vessel damage
- Bone break during surgery
- Dislocation of the artificial joint
- Allergic reaction to the artificial joint (common)
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
- Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day.
- If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing.
- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
- You may want to visit the physical therapist to learn some exercises to do before surgery. The physical therapist can also teach you how to correctly use crutches.
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
- Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After surgery, you will most likely need to stay in the hospital for at least one night. You may have received a nerve block that controls pain for the first 12 - 24 hours after surgery.
Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the ankle joint may be left in your ankle for 1 or 2 days. To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting.
Your doctor may recommend physical therapy to teach you exercises that will help you move more easily.
Outlook (Prognosis)
A successful ankle replacement will likely:
- Decrease or get rid of your pain
- Allow you to move your ankle up and down
Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.
References
Ishikawa SN. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 5.
Hansen ST Jr. Post-traumatic reconstruction of the foot and ankle. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, Krettek C, eds. Skeletal Trauma. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.
Reviewed By: A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, and David R. Eltz; and Gregory C. Berlet, MD, and Jaymes Granata, MD, Ohiohealth Research Institute at Orthopedic Foot & Ankle, Westerville, OH. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (2/19/2011).
