Total Ankle Joint Replacement
The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, the tibia and fibula, with the talus, or ankle bone.
The surface of the ankle bones is covered with an articular cartilage. Damage to this cartilage leads to arthritis, which results in pain and impaired movement of the ankle. Infection, bone fracture, trauma, connective tissue disorders, excessive stress, and certain conditions such as rheumatoid arthritis and osteoarthritis are causes of ankle arthritis.
Diagnosis
Ankle arthritis is diagnosed after taking a history and performing a thorough physical examination of the symptomatic ankle. Imaging such as weightbearing X-rays, CT and MRI may be ordered to confirm the diagnosis.
Treatment
Conservative treatment of ankle arthritis involves oral medications and joint injections. However, for patients who are unresponsive to conservative treatment, ankle joint replacement surgery is a surgical option.
Ankle joint replacement, also known as total ankle arthroplasty, is a surgical procedure performed to relieve pain and immobility due to ankle arthritis.
Surgical procedure
Ankle joint replacement surgery is performed under general anaesthesia. An incision is made over the front of the ankle. The muscles and tendons are retracted to expose the ankle joint. The damaged part of the tibia, fibula, and talus bones are then removed using special instruments, and the remaining part of the bones are reshaped to fit the new artificial joint or prosthesis.
At the end of the surgery, tendons and other structures are placed back in position covering the new joint and the wound is sutured closed and covered with a sterile dressing.
Post-operative care
Following ankle joint replacement, you may need to stay in the hospital for 2-3 days and will be advised on precautions for a successful recovery.
The treated ankle will be immobilised with either a plaster or boot. Patients are advised not to put any weight on the ankle for at least 6 weeks and to use crutches, a frame or a knee scooter for mobilisation. Swelling and discomfort can be managed by taking prescription pain medicines, applying ice packs, and by elevating the ankle above heart level while resting. Sutures are removed after 2 weeks, and once the wound is well healed you will be referred to physiotherapy to regain range of motion of the new ankle. Patients should avoid smoking, alcohol consumption, and should eat a healthy diet for the best outcome.
Risk and complications
As with any major surgery, there are potential risks involved. The possible complications associated with ankle joint replacement include infection, fracture of the bones, dislocation of the ankle joint, damage to nerves or blood vessels, blood clots (DVT/PE), loosening of artificial components, failure to relieve pain, instability and stiffness. Further surgery can be required.
Total ankle replacement surgery is used to treat the pain and immobility of severe end stage arthritis that has not responded to non-surgical treatments. The goal of ankle joint replacement surgery is to eliminate your pain and increase the mobility of your ankle joint.