Definition

Ankle replacement is surgery to replace the damaged bone and cartilage in the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. There are different types of ankle replacement surgeries.

Alternative Names

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery

Description

Ankle replacement surgery is most often done while you are under general anesthesia. This means you will be asleep and not feel the pain.

You may have spinal anesthesia. You can be awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be given medicine to help you relax during the operation.

Your surgeon will make a surgical cut in the front of your ankle to expose the ankle joint. Your surgeon will then gently push the tendons, nerves, and blood vessels to the side. After this, your surgeon will remove the damaged bone and cartilage.

Your surgeon will remove the damaged part of:

• The lower end of your shin bone (tibia).
• The top of your foot bone (talus) that the leg bones rest on.

The metal parts of the new artificial joint are then attached to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. A piece of plastic is inserted between the two metal parts. Screws may be placed to stabilize your ankle.

The surgeon will put the tendons back into place and close the wound with sutures (stitches). You may need to wear a splint, cast, or brace for a while to keep the ankle from moving. You will also be instructed to not put weight on the leg until the implant has healed into the ankle.

Why the Procedure Is Performed

This surgery may be done if the ankle joint is badly damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

• Arthritis caused by ankle injuries or surgery in the past
• Bone fracture
• Infection
• Osteoarthritis
• Osteonecrosis
• Rheumatoid arthritis
• Tumor

You may not be able to have a total ankle replacement if you have had ankle joint infections in the past.

Risks

Risks of any surgery and anesthesia are:

• Allergic reactions to medicines
• Breathing problems
• Bleeding
• Blood clot
• Infection

Risks of ankle replacement surgery are:

• Ankle weakness, stiffness, or instability
• Loosening of the artificial joint over time
• Skin not healing after surgery
• Nerve damage
• Blood vessel damage
• Bone break during surgery
• Dislocation of the artificial joint
• Allergic reaction to the artificial joint (extremely uncommon)

Before the Procedure

Always tell your health care provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners (such as Warfarin or Clopidogrel) and other medicines.
• Ask which medicines you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your provider who treats you for these conditions.
• Tell your provider if you have been drinking a lot of alcohol, more than 1 drink per day for women or 2 drinks per day for men.
• If you smoke, you should stop. Ask your provider for help. Smoking can slow down wound and bone healing. It will significantly increase your complications after surgery.
• Always let your provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You may want to visit the physical therapist to learn some exercises to do before surgery. The physical therapist can also teach you how to correctly use crutches and a walker.

On the day of your surgery:

• You will most often be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the medicines you were told to take with a small sip of water.

Your provider will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will most likely need to stay in the hospital for at least one night. You may have received a nerve block that controls pain for the first 12 to 24 hours after surgery.

Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the ankle joint may be left in your ankle for 1 or 2 days. During your early recovery period, you should focus on keeping the swelling down by having your foot raised higher than your heart while you are sleeping or resting.

You will see a physical therapist, who will teach you exercises that will help you move more easily. You most likely will not be able to put any weight on the ankle for a few months.

Outlook (Prognosis)

A successful ankle replacement will likely:

• Decrease or get rid of your pain
• Allow you to move your ankle up and down

In most cases, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

References

Murphy GA. Total ankle arthroplasty. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 10.

Myerson MS, Kadakia AR. Total ankle replacement. In: Myerson MS, Kadakia AR, eds. Reconstructive Foot and Ankle Surgery: Management and Complications. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 18.

Rammelt S, Zwipp H, Hansen ST. Posttraumatic reconstruction of the foot and ankle. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 68.