Total Ankle Replacement Surgery

Total Ankle Replacement Surgery

May-25-2020

Total ankle replacement (AKA Total Ankle Arthroplasty), is a surgical procedure done by a foot & ankle surgeon. This procedure’s aim is to relieve pain and keep the motion in an arthritic or injured joint. 

Total ankle replacement (TAR) is an alternative treatment option for ankle fusion. Ankle fusions can relieve pain, but since the procedure permanently fuses the bones together, it does limit the motion of the ankle joint. 

The Affected Area: Tibiotalar Joint

  • Your ankle joint (AKA the Tibiotalar Joint), consists of your fibula, tibia, and talus bones. 
  • The talus bone is situated between your leg and your foot and works together with your fibula and tibia in everyday life. 
  • The fibula bone is the smaller bone of your lower leg, while the tibia is your shinbone and is much larger.

Total Ankle Replacement Surgery for Arthritis

A total ankle replacement treats conditions that can cause ankle pain and discomfort, such as ankle arthritis. Ankle arthritis starts with the deterioration of cartilage that then causes an ankle joint to become stiff. This stiffness can often affect your quality of life. 

Common causes of arthritis, such as in your knee or hip usually results from “wear and tear,” whereas ankle arthritis commonly occurs after injury to the ankle such as an ankle fracture, chronic instability, or malalignment of the leg. In fact, only a small fraction of ankle arthritis originates from the “wear and tear” of the ankle joint solely.

Who Qualifies And Who Doesn’t For a TAR?

Depending on your ankle’s disease, age, weight, and activity level, your doctor may recommend a TAR rather than an ankle fusion. If you have painful arthritis in your ankle, and all traditional treatment has failed, you may want to discuss a total ankle replacement with your doctor.

  • Older patients: Typically, older patients place less demand and impact on the ankle joint, which makes them great candidates!
  • Younger patients: However, younger patients in their 50’s are beginning to have TAR as well.
  • Ankle joint past infections: A total ankle replacement is not advised if you have an active or previous deep infection in the ankle joint, insufficient bone to support metal and plastic implants, or neuromuscular disorder that can cause poor muscle tone and function in the ankle. 
  • Charcot neuropathy: Also, patients with Charcot neuropathy, a loss of feeling in the foot and ankle, are not ideal candidates. 
  • Ankle deformities: Additionally, it is not advised for patients with severe ankle deformities, prior ankle fusions, or poor muscle quality at the surgical site.

The Difference Between Ankle Fusion & Total Ankle Replacement

Your foot & ankle surgeon will initially treat ankle arthritis with anti-inflammatory medication, steroid injections, physical therapy, and braces.

These traditional measures may fail to provide pain relief, which means your daily life can continue to be affected. At this time, your foot & ankle surgeon might recommend an ankle fusion or total ankle replacement. 

As mentioned previously, an ankle fusion involves fusing together all bones of the ankle joint. Fusion restricts motion at the joint and delivers pain relief. On the other hand, an ankle fusion can lead to heightened stress and wear on the adjacent joints of the foot, which can lead to additional arthritic changes.

What Does a Total Ankle Replacement Surgery Consists of?

During a total ankle replacement surgery, the surgeon removes the arthritic cartilage and bone from the ankle joint and replaces it with metal and plastic implants. The goal with any surgery is to alleviate pain, but the key goal of a TAR is to have a patient regain their range of motion, enhancing their quality of life. 

An advantage of a TAR is that the neighboring joints of the foot do not take any added stress.

TAR Procedure

The surgeon typically performs this procedure under general anesthesia with a nerve block around the knee for postoperative pain control. A tourniquet is placed around the thigh to control bleeding and enhance visualization of the surgical area. Depending on the type of implant used, the surgeon will make an incision in the front or side of the ankle. A guide is fixed on the bones of the ankle, and the surgeon will create cuts in the bone. These cuts in the bone allow for the placement of metal and plastic components that will recreate an ankle joint. All positions are viewed with an x-ray to determine correct locations before these cuts are made.

Some patients have tight calf muscles or Achilles tendon, which connects the calf muscle to the heel bone. These patients might also require these to be lengthened to improve the range of motion at the ankle joint. If needed, this procedure will take place during the same surgery. The surgeon then closes all incisions with sutures and/or staples, and the ankle is positioned in a splint.

Post-Surgery of a Total Ankle Replacement

After surgery, you will spend 1 to 2 nights in the hospital. Some surgeons will perform this procedure as an outpatient procedure in a hospital or surgery center. After returning home, your physician will give you a strict elevation regimen. You will follow this for several days to reduce swelling and improve wound healing. Anticipate being non-weight bearing in a splint or cast for 3-4 weeks, transitioning after week 4 into a walking boot.

Early range of motion with a total ankle replacement is dissuaded as the skin around the ankle is very thin, especially in the front of the ankle where a tendon lies just below the incision. Early motion with a TAR causes the tendon to slide back and forth beneath the incision, causing friction, which could lead to wound problems/complications. For this reason, your surgeon will immobilize the ankle for a short period after the operation to promote healing of the incision before any ankle movement.

You’ll be using this walking boot for another 3-4 weeks. Usually, after 6 weeks, patients return to regular shoe gear and start physical therapy. The goal of physical therapy is to work on strengthening and developing the range of motion in the ankle joint.

What Are The Potential Complications?

As with all surgeries, there are complications that can arise such as: 

  • Blood clots in the leg, infections, excessive blood loss and complications with anaesthesia 
  • Poor wound healing: Wound healing can also be a complication, especially in higher-risk patients who are diabetic or have peripheral vascular disease (poor circulation). Poor wound healing is frequently seen in those who smoke, as nicotine prohibits wound healing. One cigarette collapses a blood vessel for 7 hours! 
  • Wear out of plastic component: As with all total joint replacements, the plastic component between the metal devices can wear out, which could result in some loosening of the implant from the bone. Normally, this requires revision surgery to replace the implants. 
  • Fracture: A fracture of the bone on either side of the implant, whether the tibia, fibula, or talus.

If your total ankle replacement fails, there might be the option of removing the implants and undergoing an ankle fusion.

Conclusion: The Typical Results of a TAR?

The common outcome of a total ankle replacement is very successful. New implants continue to be made and developed upon within the last 30 years! Patients usually return to their full regular activity after a total ankle replacement. Surgeons will suggest low impact activity after an ankle replacement to extend the life of the implant. However, a TAR device will last 10 years or more! 

 

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