Total Ankle Replacement

What is a total ankle replacement?

A total ankle replacement is a procedure in which the doctor replaces the injured ankle joint with a plastic and metal joint.

When is it used?

The procedure may be done when the ankle joint is painful and is no longer working well, especially because of rheumatoid arthritis or trauma-related arthritis. Trauma-related arthritis results when the joint is injured either by fracture, dislocation, or damage to the ligaments surrounding the joint. Osteoarthritis is rarely a reason to do ankle replacement.

Alternatives to this procedure include:

• taking acetaminophen, aspirin, or other medicine for pain and inflammation
• limiting activity
• wearing an ankle brace
• making shoe modifications to help you walk
• applying heat in various forms
• having the ankle joint fused together surgically.

You should ask your doctor whether any of these choices would be of benefit to you.

How do I prepare for a total ankle replacement?

Within 4 weeks of the surgery, you may want to donate blood to be given back during the operation or recovery. Your doctor may also use a method for limiting your blood loss at the time of surgery.

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and find people to help you with your day-to-day duties and care for at least the first week at home.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your health care provider may give you. If you are to have general anesthesia, do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

No special preparation is needed for spinal or epidural anesthesia.

What happens during the procedure?

You will receive general, spinal, or epidural anesthesia. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation. An epidural or spinal anesthetic is a drug that should keep you from feeling pain from the waist down during the operation.

The doctor will make a cut over your ankle and expose the ankle joint. Then he or she will move the tendons aside and separate the leg bones (tibia and fibula) from the third ankle bone (talus). The doctor will remove the joint surfaces of the leg and ankle bone and secure the artificial replacement to the leg and ankle.

The doctor will put the tendons back in place. She or he may place drains in the cut to drain any blood and then close the cut.

What happens after the procedure?

You may be in the hospital for 1 to 4 days, depending on how quickly you heal. The ankle may be in a splint or cast to keep it stable. You may need blood transfusions. You may be given medicine to avoid a blood clot to the lungs and to prevent swelling. A period of physical therapy is often required after ankle replacement.

You will not be able to put weight on your ankle for the first 6 weeks. During this time you will be using crutches or a walker. You will be instructed how to take the splint off twice a day to perform range of motion exercises before you leave the hospital. The sutures will be removed about 2 weeks after surgery. Ask your doctor for other guidelines and when you should come back for a checkup.

Tell your dentists or health care providers that you have an artificial joint. If you are having dental work performed, you need to take antibiotics for the day before and the day of your dental care. Antibiotics must be used before and after any medical or dental procedure for the rest of your life.

What are the benefits of this procedure?

You will be able to move your ankle more easily and fully and less painfully. It will be easier for you to walk, and you may no longer need to use a cane or walker.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.
• An epidural or spinal anesthetic may not numb the area quite enough and you may feel some discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Spinal or epidural anesthesia is considered safer than general anesthesia.
• Nearby arteries or nerves may be damaged or cut.
• Swelling or pressure as a result of the procedure may injure the nerves in the ankle. The doctor may give you medicine to try to avoid this problem.
• Rarely, you may contract a blood-borne disease from a blood transfusion of another person's blood.
• The replacement parts may become loose or break.
• Other bones may be broken during the surgery.
• Nearby tendons may be cut, requiring a longer hospital stay.
• The new ankle joint will not move as well, or be as strong, as a perfectly normal joint.
• The new joint can be dislocated rather easily.
• There is a risk of infection and bleeding.

Ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.
• You become short of breath or cough up blood.
• You develop chest pains.
• You have unusual warmth, redness, or swelling in your ankle.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.