Total ankle replacement

The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia and fibula, with the talus, or ankle bone. The surface of the ankle bones is covered with an articular cartilage. Damage to this cartilage leads to a condition called arthritic ankle, which results in pain and impaired movement of the ankle. Infection, bone fracture, connective tissue disorder, excessive stress, and certain disease conditions such as rheumatoid arthritis, and osteoarthritis are causes of ankle arthritis.

Diagnosis

Ankle arthritis is diagnosed by your physician after taking a history and performing an examination of the symptomatic ankle. Imaging such as X-ray and MRI may be ordered to confirm the diagnosis.

Treatment

Conservative treatment of ankle arthritis involves oral medications and joint injections. However, for patients who are unresponsive to conservative treatment, ankle joint replacement surgery is recommended. Ankle joint replacement, also known as total ankle arthroplasty, is a surgical procedure performed to relieve pain and immobility due to ankle arthritis. Ankle joint replacement is also recommended for elderly patients with a severe fracture from osteoporosis, or presence of a tumour in the ankle joint.

Surgical procedure

Ankle joint replacement surgery is performed under general anaesthesia. Your surgeon makes an incision over the front of the ankle. The muscles are retracted and tendons and ligaments are moved away to expose the ankle joint. The damaged part of the tibia, fibula, and talus bone are then removed using special instruments, and the remaining part of the bones are reshaped to fit the new artificial joint or prosthesis. A bone graft is inserted between the tibia and fibula to create a fusion of the two bones and prevent loosening of the prosthesis. The prosthetics are kept in position by using special bone cement and instrumentation such as screws to support the artificial ankle. At the end of the surgery, tendons and other structures are placed back in position covering the new joint and the wound is sutured closed and covered with a sterile dressing.

Post-operative care

Following ankle joint replacement, the patient may need to stay in the hospital for 2-3 days and will be advised on precautions for a successful recovery. The treated ankle will be immobilized with the help of splints and a bulky dressing. Patients are advised not to put any weight on the ankle for at least 6 weeks and use crutches for walking. Usually a drain tube is inserted into the joint during surgery for draining blood from the incision, and is removed within 1-2 days after the surgery. Swelling and discomfort can be managed by taking prescription pain medicines, applying ice packs, and also by elevating the ankle above heart level while resting. You will be referred to physical therapy soon after surgery to regain range of motion of the new ankle. Sutures are removed after 10-15 days and one should take care that the incision is kept clean and dry. Patients should avoid smoking, alcohol consumption, and should eat a healthy diet for the best outcome.

Risk and complications

As with any major surgery, there are potential risks involved. The possible complications associated with ankle joint replacement include infection, fracture of the tibia or fibula bone, dislocation of the ankle, damage to nerves or blood vessels, blood clots (Deep Venous Thrombosis), loosening of artificial components, failure to relieve pain, instability and stiffness.

Summary

Total ankle replacement surgery is used to treat the pain and immobility of severe end stage arthritis that has not responded to non-surgical treatments. The goal of ankle joint replacement surgery is to eliminate your pain and increase the mobility of your ankle joint.