Ankle replacement surgery for arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The ankle joint is made up of the two bones of the lower leg (tibia and fibula)and the talus. It is often called the tibiotalar joint.

The ankle supports a force about five times body weight when a patient walks. Normally, the cartilage in the ankle joint cushions the bones.

But when cartilage is destroyed or seriously damaged due to arthritis, the pain can be debilitating. When this pain can no longer be managed with conservative measures such as medication or braces, a doctor may recommend surgery. Careful evaluation of the particular ankle problem, lifestyle and expectations will help determine which type of surgery is best. Surgical options include arthrodesis (ankle fusion) and ankle replacement (or total ankle arthroplasty).

Arthrodesis is the fusion of three bones: tibia, fibula and talus. This operation is excellent for pain relief but sacrifices the range-of-motion of the foot that normally occurs through the ankle.

Ankle replacement is a procedure that has been available for approximately 25 years. However, it has not been as successful as hip and knee replacement surgery. Because the ankle is not as often involved in arthritis, there has been less study devoted to this area. Over the last 10 years ankle arthroplasty has been growing in popularity as the implants available for replacement have improved. Current studies indicate about a 90 percent patient satisfaction rate in the first four years after surgery.

Ankle replacement surgery is a good option if a patient does not participate in high impact activities. It's better suited for people with little bone deformity, no history of infection in the ankle joint or dead bone (avascular necrosis). Most people who have ankle replacement surgery suffer from osteoarthritis, rheumatoid arthritis or arthritis caused by prior trauma such as a broken ankle. Ankle replacement leaves a patient with reasonably good range-of-motion in the foot and a near normal gait. After surgery, a patient may walk and play golf, for example, but should not do higher impact exercises like step-aerobics, plyometrics, or running.

Ankle fusion is often the recommended surgical option for people with severe ankle joint deformity, a history of infection or dead bone or an inability to move the foot due to a neurologic condition.

Recovery time generally takes two to three months. The ankle will be in a cast, and a patient will have to use crutches. Unlike rehabilitation following total hip and knee replacements, little physical therapy is needed after ankle fusion or replacement. Patients do their own therapy by gradually increasing the weight load they put on the repaired ankle.

The short term complications associated with total ankle surgery are rare, but can be devastating. Infection can lead to removal of the implant.

Long term problems include implant loosening and inflammation from prosthetic debris. Failure of the prosthesis is another complication.

Since the implant is made of mechanical parts, all mechanical parts degrade over time. Ideal candidates are elderly, inactive people with end stage arthritis who place little demand on the replacement.

Possible complications of ankle replacement or ankle arthrodesis include: infection, injury to nerve or blood vessels, fracture, failure of the bone to adhere to the ankle replacement, failure of the bones to knit together, wound healing problems and blood clots.

There are also rare cases of pain syndromes such as reflex sympathetic dystrophy reported from any foot, ankle, hand, or arm surgery. There are also risks of anesthesia.

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