Introduction
Ankle replacement is a procedure performed to replace the damaged ankle joint with an artificial joint. Ankle replacement is generally carried out to treat arthritic conditions such as osteoarthritis or rheumatoid arthritis in which the ankle joint wears out or becomes inflamed and painful.
Indications and contraindications
Ankle joint replacement is indicated when conservative treatments such as medications, exercise, physiotherapy, ankle support or shoe inserts have failed to provide relief from arthritic pain.
Ankle joint replacement is contraindicated in the following situations:
- Young and physically active individuals
- Severe foot deformity
- Unstable ankle
- Previous ankle joint infections
- Collapsed talus (bone under the ankle)
Procedure
Ankle joint replacement is performed under the effect of general or spinal anesthesia. Your surgeon will make a 6 inch long incision on the front of the ankle and remove the damaged joint surfaces. The ankle joint is then replaced with an artificial joint which consists of two pieces of metal and a hard plastic pad between the metal pieces. This artificial prosthesis allows free movement of the joint. Special coating is used to fix the replacement to the ankle bones and the skin is sutured or clipped. Additional surgery such as heel cord lengthening may be required at the same time to allow complete movement of the ankle joint.
Post-operative care
After the surgery, keep the operated foot elevated to help reduce swelling. After the swelling has reduced, the foot will be put into a plaster cast from knee to the toes for about 6 weeks until the bones have fused. You may have to use crutches while walking for a few weeks. Approximately 2 weeks after the surgery, your ankle will be evaluated and a plaster or brace is applied. The plaster or brace will be removed after 6 weeks and X-rays will be performed to check the position of the ankle replacement. Physiotherapy will be advised to improve the mobility of the joint. Avoid vigorous exercises and long hours of driving for a few weeks after the surgery.
Risks and complications
As with any procedure, ankle joint replacement involves certain risks and complications. They include:
- Ankle infection
- Pain
- Loosening of the artificial ankle joint
- Nerve damage
- Repeat surgery for failed ankle replacements
- Rarely, deep vein thrombosis or pulmonary embolism