ANKLE REPLACEMENT
If you have severe pain caused by ankle osteoarthritis (wear and tear), you’ve likely been putting up the problem for a long time.
Is your ankle painful and stiff, or have you been told you told you have ankle arthritis? Not sure if you should have an ankle fusion or ankle replacement? I’m here to help.
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Why Does Ankle Arthritis Happen?
The commonest reason that wear happens within the ankle is previous trauma to the ankle, such as an ankle fracture. You may have experienced a nasty sprain, even years ago, that created some initial damage the joint surfaces, you may have experienced some instability in your ankle, or have kept going over on it.
Once the ankle is worn, it becomes painful and sometimes, despite physiotherapy, injections, or even keyhole surgery, you might find yourself with two options.
Either, you have a fusion of the ankle joint (which may be the best option for you), or, you might be suitable for ankle replacement surgery.
How is Ankle Osteoarthritis Diagnosed?
What is Ankle Replacement Surgery, and Who is It Suitable for?
The goal of ankle replacement is to treat your pain whilst maintaining mobility in your ankle.
Ankles are complex joints. They move in three different planes; you can flex your ankle up and down, but it also rotates too, which is why the earlier kinds of ankle replacements didn’t work very well.
Although ankle replacements are designed to withstand high loads, because of the small surface area involved they are more prone to failure than hip or knee replacements. So, if you intend to continue subjecting your ankle to high impact activities, you might be better served by a fusion surgery.
The people who do best are older patients (e.g. over the age of 65), and who have less demands on their legs. How your ankle has worn down is also very important. If your ankle has worse nice and evenly from left to right, then ankle replacements tend to last longer. If your ankle has worn out unevenly and there is a large tilt on your x-ray, then perhaps an ankle fusion may be a better option.
What Happens During an Ankle Replacement?
I regularly say to my patients that ‘half of the operation is done online’. There’s a lot of planning that goes into an ankle replacement, and every patient has a tailor-made element to their replacement. I’ll ask you to go for a CT scan of your lower leg, and your images are then sent to a group of specialist design engineers in America. They construct the images into a 3D model, and I use that model online to determine the best implant size, position, rotation, and alignment precisely for your individual anatomy.
Once this process is done, and I have approved the final specifications, patient-specific cutting guides are made that only fit your ankle and no one else’s. This allows your ankle replacement to be implanted in the best most accurate way possible that is ideal for your specific anatomy only. The implant is called the ‘Prophecy’ and is manufactured by Wright Medical.
Because a large part of the operation is done before you even arrive in the operating theatre, this speeds up the operation and allows you to recover earlier with less pain and less side effects.
What’s It Like to Go Through Ankle Replacement Surgery?
The surgery takes place under a general anaesthetic, and you stay a night in the hospital. When you wake up, your leg will be numb for several hours.
Your leg will partially be in plaster (a ‘back slab’) for two weeks. You won’t be able to weight bear on the ankle during this time, so you’ll either need to use crutches, a ‘strideon’ or an ‘iwalk’.
At two weeks, we meet again, and the cast will be removed, and you’ll go into a weight-bearing boot which you can take off at night-time.
This is a good time to start some physiotherapy to get the ankle moving, and to start some gentle muscle-building exercises.
You’ll be rather limited with your activities for around six weeks, whilst things heal up.
It will take several months before you can do activities such as tennis, and it’s best to avoid impact activity for the first six months, and it can take a good year for the ankle swelling to disappear, and for you to really reap the benefits.
You will however notice that the arthritis pain has completely gone from day one.
6 weeks after ankle replacement surgery..
How Successful is Ankle Replacement Surgery?
We talk about joint replacement success in terms of how long they last (or ‘survive’). A recent study showed that the 10 year survival rate for ankle replacements is around 85% – in other words, 85% of them are lasting at least 10 years. But these results include the older designs of ankle replacement. Further studies are ongoing all the time to understand what works best especially as more technology progresses.
If the ankle replacement eventually breaks down and fails, it may be possible to remove and replace the part that is the issue – either the top or bottom surface of the ankle replacement. Sometimes that’s not possible, and if so, a fusion operation is a good next option.
