Total ankle replacement is a surgical procedure designed to relieve pain and restore mobility in individuals suffering from severe ankle arthritis. Similar to a total knee replacement, this procedure involves removing the damaged joint and replacing it with a metal component on both the talus and tibia sides, with a plastic spacer in between that allows for smooth movement.
Ankle Replacement vs. Ankle Fusion
One of the most significant differences between ankle replacement and ankle fusion is mobility. Ankle fusion eliminates movement in the joint by using plates and screws to secure the bones together, which helps relieve pain but affects walking patterns and flexibility. In contrast, ankle replacement preserves motion, allowing for a more natural gait while also alleviating pain.
Who is a Good Candidate for Total Ankle Replacement?
The ideal candidate for total ankle replacement is typically 50 years or older with arthritis in the ankle. While some patients may develop arthritis without a prior injury, most ankle replacements are performed due to trauma, such as a previous fracture or significant ligament damage that led to joint deterioration. In comparison, knee replacements are more commonly done for primary, age-related arthritis. Patients should have minimal deformity, good pre-surgical motion, no history of infections, normal nerve function, and adequate blood supply. If a patient has very limited motion, an ankle fusion may be a better option.
The Evolution of Total Ankle Replacement
Total ankle replacements have significantly improved over the years. Initial attempts in the 1970s were unsuccessful due to poorly designed implants. By the late 1990s, new designs like the Agility Ankle became more effective. Modern advancements now include patient-specific implants created using CAT scans, ensuring precise placement and improved motion. These newer implants are also more modular and easier to revise when necessary.
Non-Surgical Alternatives to Ankle Replacement
While there are no direct non-surgical alternatives to ankle replacement, patients can explore non-surgical treatments for ankle arthritis. Options include non-steroidal anti-inflammatory medications, ankle braces, or rigid braces that mimic ankle fusion by limiting movement.
Risks and Complications of Total Ankle Replacement
Total ankle replacement surgery typically lasts between one to two hours, depending on the complexity of the procedure and any additional repairs needed, such as removing prior implants or fixing tendons. As with any surgery, total ankle replacement comes with potential risks. The most common complications include wound healing issues, infections, and implant loosening. Early complications involve the bone failing to grow into the implant, which typically stabilizes within six months. Over time, the implant may loosen or experience wear, requiring revision surgery. Additionally, bone overgrowth around the implant may lead to impingement, necessitating future clean-ups.
Recovery Timeline After Total Ankle Replacement
Most patients go home the same day after surgery, with about 80% discharged within hours. Recovery follows a structured timeline:
- Weeks 1-4: Non-weight bearing to allow bone integration.
- Weeks 4-8: Gradual weight-bearing in a boot.
- Week 8+: Transition to normal footwear, such as sneakers.
Full recovery takes approximately three to six months, with continuous improvements in strength and mobility.
Role of Physical Therapy in Recovery
Physical therapy is crucial after ankle replacement. Therapy focuses on wound healing, tissue mobilization, restoring ankle movement, gait training, balance exercises, and strengthening the hips and core. These steps help patients regain stability and confidence in their mobility.
Longevity of Ankle Replacements
While it is difficult to predict exact longevity, studies suggest that around 85-90% of ankle replacements last at least 10 years. Ankle replacements function similarly to a set of tires—wear depends on usage and overall alignment of the ankle implant. Many patients experience much longer-lasting results, though durability depends on individual activity levels and joint stress. Many patients have already adapted their lifestyle due to pain, but after surgery, they can resume walking, playing pickleball, tennis, and golf, and even light jogging. However, high-impact activities like soccer, basketball, and football can accelerate wear and are generally discouraged.
Signs That an Ankle Replacement May Need Revision
Patients should be aware of signs that indicate potential implant failure, including increasing pain and swelling, clicking or popping sensations, or a return of daily discomfort. If these symptoms arise, it is essential to consult a specialist to determine if revision surgery is needed.
Take the Next Step
If you are experiencing chronic ankle pain or mobility issues due to arthritis, total ankle replacement may be the solution for you. Book a consultation with Dr. Keith Heier at OrthoTexas today to discuss your options and regain pain-free movement.
