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6 Conditions That May Need Total Ankle Replacement

April 18, 2023

Ankle arthritis is treated through total ankle replacement, often known as ankle arthroplasty. The operation can assist in alleviating ankle pain, enhancing joint stability, and boosting general mobility. A total ankle replacement is only recommended after other therapies have failed to address the symptoms of ankle arthritis.

What Exactly is a Total Ankle Replacement?

A total ankle replacement surgery is a type of joint replacement procedure. Ankle arthroplasty is another name for it. It replaces injured ankle parts with a prosthesis (plastic or metal). These artificial components function and move in the same way as your natural joint. This treatment is mainly reserved for those with persistent ankle pain that interferes with their quality of life.

What Can Ankle Joint Replacement Treat?

Ankle arthritis is often treated with a total ankle replacement surgery. Arthritis is caused by changes in the cartilage (tough tissue) that covers the bones of a joint. The cartilage thins and becomes rougher. Ankle arthritis can develop with age due to regular wear and tear. Repetitive ankle traumas, fractures, or certain medical disorders can also cause it.

A total ankle replacement may be needed in case of severe joint swelling.

Common symptoms of ankle arthritis include:

·       Joint pain

·       Joint swelling

·       Difficulty walking

Most patients find relief from ankle pain and other symptoms with simple therapies, which are frequently combined. Doctors refer to these treatments as "conservative therapies." Medication, physical therapy, or orthotics (specific shoe inserts or devices, such as braces, to reduce discomfort) may be included. However, severe ankle arthritis may necessitate more specific treatment. When this occurs, a healthcare physician may recommend total ankle replacement.

Who Should Not Have Ankle Replacement Surgery?

Ankle replacement is not always the best option for those with ankle arthritis. Your ankles may only fit you well if they are well-formed and stable. Similarly, for patients with specific medical issues, healthcare experts may not propose replacement:

·       Circulatory problems

·       Bone infections

·       Obesity

·       Diabetes

The first step is for you to talk to a healthcare expert, who will conduct a physical exam and x-rays to evaluate whether you are a candidate for an ankle replacement. Ankle replacement surgery isn't the only kind of ankle surgery. If ankle replacement is not the best option, additional options include ankle fusion or ankle arthroscopy.

Why Do I Need A Total Ankle Replacement?

There are several key reasons why orthopedic surgeons offer ankle arthroplasty to patients, including the following:

Advanced Arthritis

Patients with severe osteoarthritis of the ankle joint frequently have the joint replaced. As the cartilage in the ankle goes away due to arthritis, swelling, and inflammation create stiffness and pain. The ankle could become immobile.

Similarly, rheumatoid arthritis puts you at risk of requiring an ankle replacement. The condition could degrade the bone in the ankle joint, resulting in deformity and impairment.

Chronic Ankle Pain

Chronic ankle pain may indicate that the ankle needs to be replaced. The discomfort could be caused by a sports injury or trauma from an accident or a fall.

Disability

When alternative therapies fail, limited mobility and loss of ankle range of motion may indicate the need for a total ankle replacement.

Weakness in the Ankle

A customer happy about a pain-free procedure.

Extreme ankle weakness is frequently a symptom that the ankle bones are failing. As a result, an ankle replacement will allow you to regain movement and function in your leg and ankle.

Ankle Instability

Multiple ankle sprains, particularly in childhood, might produce the ideal storm necessitating ankle surgery. For example, people who sprain their ankles regularly while playing sports may notice that the ankle has become less stable than previously.

Because the ligaments are weak from over-stretching, instability increases the likelihood of re-spraining. Ligaments can become loose if they are torn and do not fully mend.

Fracture

Severe ankle fractures that do not heal adequately might result in a loss of ankle joint range of motion. A total ankle replacement may be the best treatment for resolving this issue and restoring full functionality.

What Should I Do To Prepare For Complete Ankle Arthroplasty?

Having realistic expectations before surgery and rehabilitation (healing) is critical. Discuss how to prepare for the surgery with members of your care team. Knowing what to expect may allow you to prepare for difficulties and establish recovery plans. Before surgery, your team may advise you to:

·       Stop taking certain medications

·       Stop smoking

·       Start physical therapy

Talk to your friends and family regarding how you plan to recuperate. After your ankle replacement, you will have difficulty walking. Make a strategy for completing daily tasks. You may require grocery shopping, stair climbing, or pet care assistance.

Recovery After Ankle Replacement Surgery

Discuss your post-surgery expectations with your healthcare physician. Your medical staff will continue to follow you as you recuperate closely. Your leg will most likely be immobilized and raised when you wake up. As soon as you're able, you can resume your normal diet. You may require more X-rays to see how well your procedure went. You will likely have to stay in the hospital for a few days.

You may experience substantial discomfort immediately following surgery, but pain relievers may help. The discomfort should start to fade after a few days, and you should be in less pain than before the procedure.

You need to wear a splint after a total ankle replacement.

You'll likely have to wear a splint for a few weeks after surgery. You may also need crutches for several weeks. While you recover, your orthopedic specialist will teach you how to move your foot. Resting and elevating your leg for the first week following surgery may be beneficial. You won't be able to bear full weight on your foot for a few months.

You won't be able to see the incision at first, but notify your healthcare practitioner immediately if the pain worsens or you have a high temperature or chills.

Keep your follow-up appointments so your healthcare practitioner can track your improvement. A few weeks following surgery, your splint may be removed and replaced with a boot or cast. This cast may be removed many weeks following surgery. Physical therapy may be required for a few months to help you maintain your strength and range of motion. It could take many months before you can resume all of your old activities.

Following your healthcare provider's recommendations for rehabilitation, medications, and wound care should improve your chances of a happy outcome.

What Are The Benefits Of Ankle Replacement?

An ankle replacement allows you to regain ankle strength and stability. The procedure also keeps the range of motion intact. The replacement components articulate or move together in the same way that your natural joint does. This adaptability may enable you to walk properly, with less pain, and resume a more active lifestyle.

Ankle replacement is frequently preferred over ankle fusion (arthrodesis). Fusion surgery permanently connects the ankle bones, restricting the range of motion. This loss of flexibility might impact your walking style and trigger arthritis in other joints. Discuss with your provider which operation — ankle replacement or ankle fusion — best meets your needs.

Why Are Total Ankle Replacements Performed Less Frequently Than Other Ankle Arthritic Procedures?

Previous total ankle replacement designs did not regularly produce acceptable long-term results. Nevertheless, new implant designs are now available, and the first results are promising. Despite these positive findings, most orthopedic surgeons are still prepared to suggest total ankle replacement in all their ankle arthritis patients until longer-term studies are done.

Why Are Total Ankle Replacements Sometimes Have To Be Done In Two Staged Treatments?

Many patients who seek total ankle replacement for severe ankle arthritis often have a deformity in other foot joints or arthritis. Because the main goal of total ankle replacement is pain alleviation, any other sources of pain must be addressed for the procedure to be successful. Fusions of less important joints in the midfoot or hindfoot might be required to relieve discomfort.

A total ankle replacement may be done in two treatments.

Furthermore, suppose the foot or ankle has a deformity, like a tight Achilles tendon, a severely flat foot, or an ankle that turns out. In that case, the load on the new ankle replacement would be considerable, leading to premature failure. In rare circumstances, additional treatments might be performed concurrently with the total ankle replacement operation. However, in many instances, these additional surgeries are substantial and necessitate recovery time before the total ankle replacement, necessitating two-phased treatments split by weeks or months.

How Long Should My Total Ankle Replacement Last?

Recent research shows up to 90 percent of total ankle replacements are still functional five years after surgery. After eight years, this figure reduces to around 80%. The ankle replacement's longevity is greater in patients with less ankle deformity before surgery. The main source of worry is a need for adequate evidence on the long-term outcomes of total ankle replacements. While the outcomes at five and eight years are positive, we have yet to determine the results at 15 or 20 years. Most patients would require some form of revision operation 10-15 years after the initial surgery, according to the best estimates.

© 2024, John Hibbitts, M.D. All Rights Reserved.