Ankle replacement surgery, known as ankle arthroplasty, is a procedure in which the damaged ankle joint is entirely removed and replaced with an implanted metal or plastic prosthetics. The ankle joint is composed of 2 bones and their junction, the first, the tibia or “shin” bone, the second, the talus, a large bone at the top of the foot. Together, they make the tibiotalar joint, more commonly known as the ankle joint. In a joint, the ends of bones rub and glide against each other to achieve motion. A strong tissue called cartilage covers these bone surfaces to reduce friction and wear.

Over time, however, as we age and continue to use these structures, the cartilage will wear down and become weaker, resulting in inflammation, pain, and sometimes stiffness. Arthritis is a condition referring to this inflammation of the joint and its associated tissues. With severe arthritis, a total ankle arthroplasty (TAR) may be utilized when other treatment options have failed to alleviate symptoms.

First, a orthopedic surgeon will make an incision a few inches long across the anterior (front) ankle in the procedure. From here, the damaged talus will be removed, as will a portion of the lower tibia. Next, a prosthetic joint, made of metal surfaces and high-density polyethylene, a type of plastic, is implanted into the space and stabilized to the existing bones of the foot and leg. This specific plastic is widely used and chosen for its low rigidity and hardness and its high impact strength and friction reduction properties.

This procedure is usually performed under general anesthesia with a nerve block applied to the area to block pain signals sent to the brain. Narcotics will likely be prescribed for pain management post-surgery as well. Overall, this surgery aims to reduce debilitating pain associated with arthritic conditions, though the downfall is the elimination of movement ability in the joint.

Total ankle arthroplasties are used as a last resort treatment for those experiencing debilitating arthritic pain, impeding a patient’s ability to perform activities for daily living. Before considering an arthroplasty, all other treatment options will likely be tried, including other operative procedures like arthrodesis, the surgical fusion of bones in a joint; in this case, that would be the tibia and talus.

Osteoarthritis, a condition characterized by the gradual wearing of cartilaginous tissue, and rheumatoid arthritis, an autoimmune disorder in white the body attacks its cartilage, can become severe enough to need an ankle arthroplasty.

The ideal candidate for a total ankle replacement is over the age of 50, weighs less than 250 pounds, has severe arthritis pain, a low physical activity, and no deformities of the talus or calcaneus, more known as the heel bone. Patients over 70 needing a TAR are likely to see worse outcomes and an increased risk for operative complications. Those with a high activity level should not have this procedure performed, as the immobilization of the joint will impact their day-to-day activities, and a higher activity level increases the wear of the prosthetic joint. Another contraindication is obesity and diabetes.

Obesity is a concern due to the excessive weight placed on the ankle joint. Though there may be a higher number of patients needing a TAR and have diabetes, taking into account the high comorbidity rate of diabetes and arthritis, the disease poses too much risk of further damage to the joints. ATAR may be more harmful than beneficial.

Further, those with bone loss, low bone density, or osteoporosis, a condition in which the bones become brittle, are all contraindications of the procedure, as a solid bone base is necessary for an effective prosthetic implant.

Before considering a total ankle replacement, your doctor will gather a comprehensive health history and will likely perform exams, tests, and medical imagery to determine if you have any heart, lung, or kidney conditions that would put you at risk for major surgery. A history of frequent infections is another concern, as a postoperative infection of the joint can put you in danger and destroy the prosthetic. Medications such as aspirin and blood thinners will need to be halted before and after the surgery.

Ankle replacement surgery, while not a new procedure, has picked up attention more in the past ten years as technology and prosthetics have advanced. Unfortunately, a TAR still does not have as good outcomes as a total hip or knee replacement, which are more commonly performed and studied.

Overall, patients report approximately 94% satisfaction for the first four years after surgery, decreasing to about 84% after ten years. The most-reported problem is loosening of the prosthetic, and an estimate of 33% of patients will need revision surgery within ten years of their first. Learn more about ankle replacement today by booking an appointment with The Orthopedic Group. We are here to help you get back to living life again. We serve patients from Leesburg VA, Lansdowne VA, Stone Springs VA, Dulles, VA, Ashburn VA, Sterling VA, Aldie VA, South Riding VA, Herndon VA, Winchester VA, Reston VA, and Chantilly VA.