What is an ankle replacement?

An ankle replacement or total ankle replacement surgery (arthroplasty) is a surgical procedure that replaces a damaged ankle joint with an artificial implant. The new ankle replacement consists of metal implants with a plastic spacer in between.  The ankle joint is located between your shin bone and the top of your ankle (talus) bone. Cartilage in the joint can wear away due to osteoarthritis, injury, or an autoimmune disease such as rheumatoid arthritis. Cartilage lines the end of the bone, creating the joint.  When this wears away, it can create pain, swelling and inflammation because the bones rub on each other instead of the intended surface, the cartilage. This bone-on-bone condition causes pain and eventually the loss of mobility. Our physicians, serving patients in Vail Colorado and the surrounding mountain ranges has extensive experience in performing ankle replacements or ankle arthroplasty.

Why would I need an ankle replacement?

Total ankle replacement surgery or arthroplasty may be suggested if you experience severe pain and discomfort from ankle arthritis, osteoarthritis or rheumatoid arthritis. Post Traumatic Arthritis can stem from a previous injury, osteoarthritis is caused from wear and tear over time, and autoimmune diseases can lead to cartilage wear. All of these types of arthritis affect the joint because of the loss of cartilage, or the cushion between bone joints that help the joint move painlessly. The outcome of ankle arthritis is a painful joint. If the pain level becomes intolerable after non-surgical approaches fail, surgery may help alleviate pain and restore mobility.

What occurs during an ankle replacement?

Ankle surgery may be the best option for individuals if the pain has become so severe that it interferes with daily activities. During an ankle replacement, general anesthesia is typically used. Our physicians will make 1-2 incisions and clean out damaged portions of the talus and tibia, removing any scar tissue that may be present. We will then attach the new metal implants the remaining bone and insert a durable plastic between the components which acts as cartilage. Surgery takes approximately one and a half to two hours to complete.  Our physicians often use a preoperative CT scan to create custom made, or patient specific, cutting guides to make the surgery more reliable, efficient, and reproducible.

What are the Risks of an Ankle Replacement?

The majority of ankle arthroplasty surgeries are successful, but there are certain inherent risks with the surgery. Risks can include blood clots, damage to nerves or tendons, bleeding, infection, loosening of the metallic implants, failure of the bone to heal to the ankle replacement, or misalignment of the bones. Our physicians will discuss the best options for ankle replacement and ankle fusion and will help formulate a plan for the best possible outcome.

How long does it take to recover after an ankle replacement?

Complete recovery from your total ankle replacement surgery is dependent upon the severity of the damage to the joint, patient health, age and underlying health conditions. Patients are often required to stay in the hospital for one night after an ankle arthroplasty and pain medications may be used to control post-operative pain. If a nerve block was used, the leg will feel numb for a time after the surgery.  There are options for a “single shot” nerve block which can last 12-18 hours or a “nerve block with catheter” which can last 2-3 days. The typical post-operative protocol involves splinting, a soft cast, for 2 weeks followed by the patient being placed into a CAM boot.  At 2 weeks patients typically start a 2-week weight-bearing progression within the CAM boot.  At 4 weeks most patients begin a wean out of the Cam boot into standard shoe wear.  Most patients are back in standard shoe wear at 6 weeks.  This timeframe is adjusted as needed, and is extended if there are concomitant procedures such as osteotomies (bone cuts to correct the position of the foot) or ligament repairs completed.  Physical therapy is necessary to regain strength and mobility.  Most patients are back to full activity 3-6 months after the ankle replacement.

For more information on ankle replacements, please contact the office of Sports Foot and Ankle, Orthopedic Foot and Ankle Specialists serving Vail, Colorado and the surrounding Eagle, Vail Mountain Range Community.

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