What is an ankle prosthesis?
Ankle replacement surgery involves a total replacement of the ankle joint that connects the tibia (shinbone) to the talus (ankle bone). The joint is replaced with a prosthetic joint in order to restore mobility to the foot and reduce pain. There is a wide range of prosthetic ankle joints now available, and prosthetic technology has advanced significantly over the past 30 years.
Why is it performed?
Ankle replacement surgery is performed on patients whose ankle joint has been severely affected by arthritis. It is generally recommended as an option when other measures, such as pain medications, shoe inserts or physical therapy, are not sufficient to control pain symptoms.
Most patients who undergo the procedure are over 60 years old, but sometimes it is offered to younger patients, depending on the presence of arthritis.
What does it consist of?
The procedure involves making a 6-inch long incision over the front of the ankle and then cutting away the worn surfaces of the joint. They are then replaced with a prosthetic joint. The entire operation should take about an hour to an hour and a half.
Ankle replacement surgery is usually performed under general anesthesia, but in some cases a local anesthetic may be used so that you can eat and drink immediately afterward and be discharged from the hospital sooner.
Prosthetic technology has advanced significantly in recent years.
How to prepare for surgery?
You will probably have a checkup a few weeks before the procedure to make sure you are healthy enough to have surgery. You may also be measured by a physical therapist to check how well your ankle is working so you can compare it to your ankle after surgery.
You may be asked to stop taking certain medications, such as blood thinners, a few days before the procedure.
On the day of the procedure, you will first meet with the anesthesiologist to review anesthesia options or other types of sedation.
After the operation
You will likely spend up to three days in the hospital after the operation while the swelling goes down to keep your leg elevated. Once the swelling is gone, a cast will be placed on your leg and you will be taught to walk with crutches. After this, you will be able to go home.
Depending on the clinic and your recovery, you may be in the cast for 3-6 weeks. During this time you can have a check-up with a nurse, who will remove the cast, inspect the cuts and put on a new cast.
After a few weeks, you have to visit the clinic again to check with an X-ray that the ankle has healed completely. If it has, the cast will be removed and you will be able to walk without crutches. You should receive ongoing physiotherapy from this time to mobilize the ankle.
Recovery
During the first few days you may experience some moderate pain, but this can be controlled with appropriate painkillers.
For the first two weeks after surgery you should keep weight off your foot. You will probably not be able to go to work for about 6 weeks and you will not be able to drive until you can make an emergency stop without pain in your foot.
Once your cast is removed, you can begin to increase your exercise; walking and swimming are the best ways to exercise. Your doctor will probably advise you not to participate in high-impact sports, such as rugby or squash.
Alternatives to this treatment
Ankle surgery is not recommended in patients with:
- A collapsed talus (ankle bone).
- Loss of sensation in the feet due to diabetes
- Poor circulation in the legs
- Severe deformity of the ankle
- Contagion
- Ligament instability
In these situations, an ankle fusion may be recommended instead.