Total ankle replacement

Total ankle arthroplasty
Summary

This operation is performed for symptoms caused by arthritis of the ankle.  Increasing pain and stiffness occurs as the joint surfaces get damaged.  With worsening arthritis, the pain can get so bad that it interferes with your life.  Pain killers may not help anymore and you struggle to walk any distance.  Uneven ground can be particularly difficult.  Surgery involves removing the joint surfaces and replacing it with an artificial joint.

Factors to Consider

You have been diagnosed with ankle arthritis.  It is likely that you have already tried non-surgical treatments for your ankle such as pain killers, footwear modification, physiotherapy and injections.  

If these measures have not improved your symptoms then the next logical step is to consider surgery.  An ankle replacement is a good operation to help with your symptoms and has the advantage of keeping movement in your joint.  It, however, is not appropriate for all patients with ankle arthritis.  Your surgeon will discuss whether an ankle replacement is appropriate for you.  an alternative option, if it is inappropriate, is to consider an ankle fusion. 

Description of Surgery

The operation is performed as an open procedure.  An incision is made down the front of the leg over the ankle.  The remaining joint cartilage is removed and the joint surfaces are prepared to accept the new prosthetic joint.  The position of the joint replacement is checked during the operation using x-rays.  The wound is then closed and a plaster is applied to protect the joint replacement for the first few weeks.

The operation takes about 2 hours.

Anaesthetic

The operation is usually performed under a general or spinal anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Artifical joint replacements are not as good as your own joint and so will wear out in time.  80% of ankle replacements last 10 years.  The joint replacement can fail by becoming loose, dislocating or the joint bearing surfaces wearing out.  Arthritis in the neighbouring joints can also occur in time.  

Surgery to the ankle may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the ankle may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a plaster.  Your foot will remain in plaster for the first 2 weeks and you will not be allowed to weight bear during this time.  The surgeon will give you instructions as to when you can start weight bearing as this will depend on the appearances on the Xray. You will be placed in a walking boot at 2 weeks and are likely to stay in this boot for up to 6-8 weeks following surgery.   

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you once the plaster has been removed.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 8 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within 6 weeks of your surgery.  If you have a more manual job it can take up to 12 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.