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Ankle replacement is a surgical procedure to place an artificial device in the ankle. The devices replace bone and joint structures damaged by disease or injury.
Reasons for Procedure
Severe damage to the joint from injury or illness, such as arthritis, can make it difficult to walk and do basic daily activities. This surgery may be considered if other treatment methods fail and the ankle is causing severe pain or disability.
This procedure is not for everyone. Certain factors can affect the success of the procedure. Ankle replacement may not be advised if there is:
- Dead bone tissue in the ankle
- Poor blood flow to the leg and foot
- Weak supporting structures of the ankle and foot
- Severe deformity
- History of infections
- Nerve damage, such as with diabetes
Repeated injury can lead to weak supporting structures of the ankle and foot
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Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Bone fracture on either side of the replacement site
- Blood clots
- Movement of the device
- Tissue damage to nearby structures like nerves or tendons
- Improper bone healing, which can lead to more surgery
- Allergic reaction to metals used in the replacement device
- Residual problems with pain (rare)
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
- Chronic diseases, such as diabetes
What to Expect
Your doctor may do the following:
- Physical exam, including an evaluation of the ankle and supporting structures
- Blood tests
- Imaging tests to evaluate the internal structures of the ankle, such as:
In the time leading up to the procedure:
- Arrange for a ride home.
- Arrange for help at home.
- Talk to your doctor about any allergies you have or medications you take. You may be advised to stop taking certain medications up to 1 week before the procedure.
- Do not eat or drink anything after midnight before the day of your surgery unless otherwise instructed.
- Install safety equipment in the bathroom, shower, or stairs.
- Prepare a bedroom on the first floor if possible.
- Remove any obstacles that may result in a fall, such as throw rugs or extension cords.
Ankle replacement may be done with:
- General anesthesia—you will be asleep during the procedure
- Regional anesthesia—the lower part of your body will be numb
An incision will be made in the front or side of the ankle. The damaged tissue, including areas of bone, will be removed. The remaining bone will be trimmed and prepared for the artificial joint devices. The metal and plastic devices will be inserted into and secured to the bone. One part is placed onto bone of the leg and the lower part is connected to bones of the foot. The Achilles tendon may need to be lengthened to reduce the tension from the calf muscle.
After the changes are done, the incision will be closed with stitches or staples. A bandage will be placed on the incision.
Anesthesia will prevent pain during surgery. There will be pain and discomfort after the procedure but it can be managed with medications.
This procedure is done in a hospital setting. The usual length of stay is 1-3 days. If you have any problems, you may need to stay longer.
At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
- Pain medications
- Antibiotics to prevent infection
- Medication to prevent blood clots
- A splint to immobilize the ankle
- Physical therapy to regain mobility and strength
During your hospital stay, you will:
- Learn to use crutches or a walker to keep weight off the ankle
- Learn to remove and replace the ankle splint
- Keep the ankle elevated above the heart while resting
- Do gentle range of motion exercises as advised
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
Recovery time will depend on overall health and amount of work that was done.
The ankle will not be able to support weight and may be immobilized for up to 6 weeks. Physical therapy will be recommended to help with strength, flexibility, and range of motion of the ankle.
Follow your doctor's instructions.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge around the incision site
- Ankle motion begins to decrease
- Numbness or tingling in the foot or toes
- Chalky white, blue, or black appearance of the foot or toes
- Pain that cannot be controlled with the medications you’ve been given
- Persistent nausea or vomiting
- New or worsening symptoms
If you think you have an emergency, call for emergency medical services right away.
Arthritis of the foot and ankle. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00209. Updated March 2015. Accessed May 11, 2016.
Osteoarthritis (OA) of the ankle. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 25, 2015. Accessed May 11, 2016.
Recovery room. DePuy Orthopaedics Joint Replacement website. Available at: http://www.jointreplacement.com/docs/Ankle/Replacement/Rehabilitation/following_ars.html. Updated October 23, 2007. Accessed May 11, 2016.
Total ankle arthroplasty. American Orthopaedic Foot and Ankle Surgeons Foot Care MD website. Available at: http://www.aofas.org/footcaremd/treatments/Pages/Total-Ankle-Arthroplasty.aspx. Accessed May 11, 2016.
Total ankle replacement surgery for arthritis. University of Washington Orthopaedics and Sports Medicine website. Available at: http://www.orthop.washington.edu/?q=patient-care/articles/ankle/total-ankle-replacement-surgery-for-arthritis.html. Accessed May 11, 2016.
by Warren A. Bodine, DO, CAQSM
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