Your ankle replacement questions answered

What is a total ankle replacement?

Total ankle replacement is an operation to replace a worn-out ankle joint (ankle arthritis) by resurfacing the ends of your tibia and talus with metal components and a plastic insert in between them to allow gliding motion.

The metal components are fixed into bones using pegs with a special coating to encourage the patient’s bone to grow into them.The plastic liner can be mobile bearing (a three component ankle) or fixed bearing (a two component ankle).

What can I expect after an ankle replacement?

Total ankle replacement provides excellent-pain relief and good function, and has a greater than 90% success rate, as measured by patient satisfaction in the short term, but like all joint replacements is prone to wear and failure with time.This appears more likely to occur in ankle replacement than in hip or knee replacements.

In most cases the range of motion after a replacement is better than before, but in some patients this is not the case, largely due to stiffness and scarring of the soft tissues. It is important that you discuss the likely range of movement you should expect with your surgeon before having your surgery, as this helps you to have realistic expectations.

In most cases, walking will be normal, so that others may not notice that you have had an ankle replacement. If you walked with a limp prior to surgery because of pain, after the surgery your walking is likely to improve. If you have other problems in the foot causing a limp, the limp may persist however.

Can I do sports after an ankle replacement?

You should be able to return to long walks, hiking, cycling and many sports such as golf, tennis, and skiing, although it might take 12 months before you find it comfortable to do. Certain contact sports like running and football, although possible are not sensible after an ankle replacement for fear of it loosening or wearing quicker than it should.

What is the best ankle replacement implant?

There are more than 13 ankle replacement prostheses on the market. Only one prosthesis has published long term (greater than 20 year) outcomes and the newest types of modern implant have only been on the market for the last 5-6 years and hence we have no long term follow up data.
In England and Wales, it is a mandated requirement to put every patient undergoing an ankle replacement into the National Joint Registry and each year the NJR produces an annual report giving the latest and most up to date outcomes on ankle replacements.

There is an ongoing clinical study, called TARVA, exploring the outcomes of ankle replacement compared to ankle fusion and this will report short term outcomes in 2020, and longer-term outcomes in 2025, and 2030.

Are there any risks undergoing ankle replacement?

As with any surgery, there are risks involved.  The main risks of ankle replacements are due to them being a new technology with uncertain long-term results. Approximately 80-90% of ankle replacements will still be in place 10 years after surgery, while some ankle replacements will loosen early (within 1-2 years) and require surgery sooner rather than later. Revision can either be to another ankle replacement or conversion to an ankle arthrodesis (fusion). An arthrodesis following ankle replacement is usually successful but is a bigger operation than if it was done in the first place.
Other more general complications following any ankle surgery include swelling, blood clots, infection, and nerve injury. At the London Ankle Replacement Centre you will be provided with patient information guides including potential risks in plain English to review prior to any surgery.
Certain patients are not suitable for an ankle replacement such as patients with a history of infection, poorly controlled diabetes, severe deformity and poor bone quality. It is important that you are assessed by a specialist as even if ankle replacement is not suitable many other treatments will be.

Are there any alternative treatments to ankle replacement?

Most patients with ankle arthritis do not need surgery. Activity modification, special ankle supports and braces and pain killers and physiotherapy help a lot of patients avoid the need for surgery. Once these treatments have been tried, there are two recognised surgical treatments. One is ankle fusion and the other is ankle replacement. There are many other invasive treatments such as PRP, Lipogemes, and stem cells. Unfortunately, many of these treatments are unproven and remain the subject of research only. We always recommend an appointment with a consultant to find out what the best option is for you.

What is an ankle fusion?

Ankle fusion (also known as ankle arthrodesis) is an operation to “fuse” or stiffen the ankle joint.It involves removing the surfaces of the damaged ankle joint and fusing the tibia to the talus bone, so that your foot is under your body and flat to the floor.

This procedure can be performed as keyhole surgery (also referred to as arthroscopic surgery) or open surgery. The surgery converts a stiff, painful joint into a stiff but pain-free one.

What can I expect after an ankle fusion?

Ankle arthrodesis provides excellent-pain relief and good function, and has a 90% success rate, as measured by patient satisfaction in the short to medium term.

Some patients express concerns regarding the level of mobility they will have following surgery. Ankle arthrodesis removes motion at the tibiotalar joint completely; however, as much as 50% of the up and down movement of the foot is maintained, because there are nearly 30 other joints that continue to work.

In most cases, if you walked with a limp prior to surgery because of pain, after the surgery your walking is likely to improve. Because the stride length is shorter, a limp may be noticeable if you start to run. Some female patients comment that it is uncomfortable or not possible to wear a high-heeled shoes after ankle arthrodesis. Most patients state that others cannot notice they have had an ankle arthrodesis.

Can I do sports after an ankle fusion?

Most patients with a successful ankle arthrodesis are able to walk without a limp even go hiking, gardening or cycling. You should also be able to do many sports such as, golf, tennis and skiing. Certain contact sports such as squash, tennis or football are not recommended as they put a lot of stress across the adjacent joints, which have to take the stresses of movement and will wear with time, and pain may then develop elsewhere in the body.

Are there any risks associated with ankle fusion?

All surgery carries general risks. The specific risks associated with ankle fusion relate to problems with union and transference of stress to the adjacent joints.

Mal-Union: Research has shown that 5 to 10% of fusions do not heal in the exact position intended. This may either be due to the fact that the position was not achieved at the time of surgery or that the bones have shifted while in plaster. This does not usually cause any major problems but rarely further surgery may be required to correct this.

Adjacent Joint Arthritis: Because the ankle joint has been stiffened, more pressure will be taken by adjacent joints, which, with time, are at risk of wearing . Signs of arthritis in the adjacent joints are common on x-rays after 10 years, but many patients do not require treatment for this.

Need for Further Surgery: Sometimes the screws become prominent under the skin. If this happens, they can be removed but only about 1 in 10 patients need the screws to be taken out. If screws need removing, we usually advise you to wait at least a year after surgery to give the bones time to become strong.

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Your ankle replacement questions answered