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What is an Ankle Replacement: Your Detailed Guide About Total Ankle Replacement and Recovery

June 5, 2023

What is an Ankle Replacement?

Total ankle arthroplasty, commonly known as total ankle replacement, is a surgical treatment for some patients with ankle arthritis.

What is an Ankle Replacement Surgery?

Ankle replacement is a surgical treatment procedure for ankle arthritis. In this procedure, portions of bone and cartilage in the joint are removed and replaced with prosthetics. It has been the preferred treatment option for patients with ankle arthritis. 

Ankle replacement surgery can remove the pain from arthritis and maintain movement at the joint. Ankle replacement helps patients perform everyday tasks like walking on uneven ground and climbing stairs without struggling. It also saves the other joints of the foot to prevent them from getting arthritis.

Anatomy of the Ankle Joint 

Medically known as the tibiotalar joint, the ankle is a complex joint that forms the articulation between the foot and the leg. The joint allows your foot to rotate and pivot with your leg. It is where the three separate bones meet to form the ankle joint, namely the following:

  • Tibia, the bigger bone in your lower limb
  • Fibula, the smaller bone on the lower part of your leg
  • Talus, sits above the heel bone and connects your leg to your ankle

Ankle Arthritis

The cartilage covers the ends of your bones, allowing them to glide together smoothly. If the cartilage in the ankle gets damaged or wears down due to injury or illness, its bone surfaces will rub each other when in motion. A worn cartilage causes osteoarthritis, joint inflammation or pain, and swelling in the ankle. Over time, the bone-on-bone grinding of osteoarthritis can wear away the bone surfaces, which can cause bone spurs and joint immobility.

What is Replaced in an Ankle Replacement?

What is an ankle replacement? Total ankle replacement is a surgical treatment for some patients with ankle arthritis.

The surface of the tibia and talus is removed. In place of the tibia and talus, metal pieces are inserted into the bone. Then, a plastic insert is attached to the tibia's metal piece. The metal component on the talus will rub against the plastic part attached to the tibial implant. The ankle replacement procedure removes the pain from the ankle suffering from arthritis and preserves the movement of the joint.

Who Needs an Ankle Replacement?

Ankle replacement is for patients who can no longer manage their ankle arthritis pain. Joint swelling may be unbearable. There are several main reasons why orthopedic surgeons advise their patients to have ankle arthroplasty, including the following:

  1. Advanced Ankle Arthritis
    • Having severe osteoarthritis significantly affecting the ankle joint is a common reason patients have the joint replaced. As the cartilage wears away due to arthritis, joint inflammation within the ankle area causes pain and constraint in movement. The ankle may even become immobilized.
  2. Chronic Ankle Pain
    • If you feel chronic pain that settles in the ankle, it may be a sign that it needs replacing. The pain you feel may result from a sports injury or damage caused by an accident.
  3. Weakened Ankle 
    • As you age, your bones may start deteriorating, which can cause extreme weakness in the ankle. An ankle replacement will enable you to recover mobility and function in your leg and ankle.
  4. Fracture
    • If you feel chronic pain that settles in the ankle, it may be a sign that it needs replacing. The pain you feel may result from a sports injury or damage caused by an accident.

Are there Non-surgical Treatment Options?

What is an Ankle Replacement?Orthopedic surgeon examines ankle to diagnose needed treatment.

Depending on your case, there are non-surgical treatment procedures available, such as:

  • physical therapy
  • use of ankle braces
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • cortisone shots

Should I Get an Ankle Replacement or an Ankle Fusion?

Both ankle replacement and ankle fusion are effective surgical treatments, as studies have shown that both offer the same pain relief. However, ankle replacement surgery provides a much better function in the ankle as it retains the joint's flexibility. 

It may vary from patient to patient; ankle replacement is sometimes impossible, and ankle fusion is the better option. Before recent technological advancements that helped ankle replacement gain acceptance, ankle fusion surgery was the acceptable treatment for arthritis. 

What is Ankle Fusion?

In an ankle fusion, two or more bones, such as the tibia and the talus, are joined with plates, screws, and bone grafts. After recovery, the bones heal together, and the ankle joint will no longer hurt. However, it will no longer bend, limiting your ankle movement.

When is the Ankle Fusion a Better Treatment than Ankle Replacement?

Depending on your case, the required ankle surgery may differ. There are various reasons why patients may not be able to undergo ankle replacement. For example, a patient's bone may be too weak or may have an ankle deformity that is not correctable through ankle replacement. It is also not a treatment option for patients with certain neuromuscular disorders in the foot and ankle. Additionally, patients with an active infection cannot have an ankle replacement. It can be treated best with ankle fusion.

How is Ankle Replacement a Better Treatment Option Today than Years Ago?

Total ankle replacements are more advisable compared to years ago. Technology and techniques improved in the medical field, allowing orthopedic surgeons and specialists to perform surgery more accurately. 

With the help of continuous medical research and advanced technology, there has also been significant progress in understanding and performing how to balance the ligaments of the ankle properly. It aligns the foot underneath the ankle during the time of ankle replacement. All of these factors contributed to better recovery for ankle replacement patients.

What are Ankle Replacement Implants Made Of?

 A total ankle replacement prosthesis is made up of two different parts:

  • Titanium metal is attached to the tibia that replaces the ankle socket. The tibia part is the second longest bone in your body. It plays a vital role in helping you stand and move. 
  • A cobalt-chrome component is connected to the talus-made metal. Talus is the bone in the lower part of the ankle and sits in the mortise joint.

 For patients with a nickel allergy, there is an option to customize an all-titanium implant.

Do Ankle Replacement Patients Undergo General or Regional Anesthesia?

Ankle replacement surgery is performed under regional anesthesia. The leg must be made numb for the surgery. The numbing medicine will last one to two days after the ankle surgery, which will also help the patient with the pain.

Before starting the ankle replacement surgery, patients receive the anesthesia to fall asleep during the surgery. Patients will breathe on their own during the procedure and are not unconscious.

Do Patients Need to be Admitted Overnight to the Hospital for Ankle Replacement Surgery?

Most patients are advised to go home on the same day as the ankle replacement surgery. There are cases that some patients may have to stay a night in the hospital but can go home the following day.

What is the Ankle Replacement Recovery Period Like?

After your ankle replacement surgery, it is casted.

After the first four weeks of surgery, your leg should consistently be elevated. You must avoid placing your weight on your foot. 

After another four weeks, you can begin walking and start physical therapy sessions. Most patients can wear regular shoes at eight weeks and begin limited movement. After four months, most of the patients feel better than they did before surgery. Usually, patients recover 75% at six months. A complete recovery is expected one year after surgery.

To help you better understand the recovery period of ankle replacement surgery, below is the detailed typical recovery timeline and benchmarks of patients. However, remember that it may still differ from patient to patient.

During the first four weeks of post-surgery

  • Immediately after surgery, the ankle is cast. In this phase, you cannot place weight on your foot. Your orthopedic surgeon will inform you about post-surgery care.
  • For the first two weeks, the ankle should be kept elevated above the level of the heart. This position minimizes swelling in the ankle and foot. It allows the incision to heal as quickly as possible. Your ankle will be elevated about 90% of the time. You can still get up for meals and use the bathroom using crutches or support.
  • After the first two weeks, the stitches from the incision will be removed. Your ankle will be placed in a removable boot. Your orthopedic surgeon will instruct you on a home exercise program. You can remove the prescribed boot to shower, sleep, and exercise well during recovery. Now, your leg must be elevated only 60% of the time.

Eight weeks post-surgery: You can start physical therapy

  • After another four weeks, little by little, you may start placing weight onto the leg using the given protective boot. You will begin physical therapy sessions.
  • Eight weeks after the ankle surgery, you can stop using the protective boot. You can return to wearing regular shoes or sneakers as you start to practice walking again.

Four months beyond

  • You will feel much better at four months than before your ankle replacement surgery.
  • At six months, usually, you will be about 75% recovered.
  • One year post-surgery, you will notice that you have maximized your movement after the ankle replacement.
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