Ankle Replacement Surgery

June 9, 2009, Chye Tuan Chng, Senior Physiotherapist

An ankle replacement surgery is where the joints of the ankle are fitted with a prosthesis or an implant to replace the existing worn out joints. It is usually recommended for the elderly and relatively inactive person as one of the major complication from such a surgery is loosening of the ankle joint due to overuse. After the surgery, you will be placed on a cast to protect the joint for a period of 6-12 weeks before you can gradually put weight on it. An ankle replacement can generally last 5 – 10 years depending on the activity level of the patient.

Who will need such a surgery?

An ankle replacement surgery is usually recommended for people with a degenerated or arthritic ankle joint that causes them pain and difficulty in moving the ankle or walking. In a degenerated or arthritic joint, the articulating surfaces are not smooth as compared to a normal joint with cartilages that allow for smooth gliding of joint surfaces over each other. The lack of smooth articulating surfaces in a degenerated or arthritic ankle can be due to either wearing away of cartilages or due to osteophytes (also known as bone spurs). This can cause pain in the ankle especially during movements of the ankle joint and on weight bearing activities like walking. With an ankle replacement surgery, an implant can be fitted into the degenerated or arthritic ankle to allow for smooth gliding of the joint surfaces, permitting pain-free movements to take place.

What happens during the surgery?

Ankle Replacement

During the operation, your surgeon will shift the soft tissues like nerves, blood vessels and muscle tendons aside so that the surgeon have sufficient space to work on the ankle joint. The tibia and talus will be shaved and resurfaced to accommodate the ankle implants or prosthesis. The ankle prosthesis consists of the tibial component which is fitted into the end of the tibia; and the talar component which is fitted on top of the talus. The fibula and tibia will be screwed together tightly to ensure that the tibial component is fitted tightly. The fibula and tibia will also be fused together by bone graft or bone cement so that the artificial ankle can move up (dorsiflexion) and down (plantarflexion) without damaging the surrounding structures.

What happens after the operation?

After the surgery, you will wake up with your leg in a cast or a splint. A tube may be attached to the ankle to drain off excessive bleeding. You will be taught to walk using crutches without putting weight on the operated foot. Your ankle will also be immobilized in a cast or ankle splint to protect the artificial joint for a period of 6 -12 weeks depending on your surgeon. One of the major complications that may arise from the operation is the loosening of the prosthesis. A typical ankle replacement may last for 5 -10 years depending on the activity level of the patient. In fact, research has shown that the artificial ankle joint has a better lifespan in an older patient than in young active patients. One of the reason is that younger patients tend to be more active than sedentary older patients and hence a higher risk of loosening the joint. In such cases, an ankle fusion may be a better alternative for this group of young patients with heavy and prolong activity requirements. Regular X-rays will be taken after the ankle replacement surgery to ensure that the implant has not moved out of place. Gradually your physiotherapist will improve on your rehabilitation exercises and introduce weight bearing activities on your ankle again.

Reference

http://www.aetna.com/cpb/medical/data/600_699/0645.html
Wood and Deakin (2003), Total ankle replacement – The results in 200 ankles. J Bone Joint Surg 2003;85-B: 334-41.

This work by Musculoskeletal Consumer Review is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Core Concepts - Musculoskeletal Healthcare Group. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). MCR's Creative Commons License does not apply in such cases.

Filed Under Ankle & Foot (NonSport), Ankle and Foot, Injury Management, Peripheral (NonSport), Sports Injury

Comments

Ruthie954

I had ankle replacemnt done 5 years ago I do not know what did but it hurts constent and swells
and discolored on the iouter left side if the ankle.
rodder5

I went to one surgeon and was aproved for STAR ankle replacement. Then the hospital stalled us because of cost factors. Went to another surgeon and he refused to do the surgery because I weighed more than 250 lbs. Is there such a weight restriction for the STAR implant? Is it by the FDA or SBI or by the DR.???
Dina Sargent

Hello all,
I am a young 34 year old woman that is in need of some advice. I had a car accident 10 years ago and the doctor botched the job causing me to have severe arthritis and my only option is ankle replacement. Now granted I have never been a person to want to go play football with my kids but I just want to walk to the bus stop and back with no problems. Did your life change with this ankle replacement. I have found one doctor in the state of PA that is willing to do the surgery. I would love feedback from people who have had this proceedure done.

Thanks
betho

Dina, I am scheduled to have an ankle replacement in April. I live in PA also..and know of several Doctors are doing it here. My Doctor is Dr. Stephanie Galey in Meadville, PA. ANd I think there is one in Pittsburgh also. I also had a 2nd opinion at the Cleveland Clinic with Dr. Brian Donley, who has done even more replacements (but said that he won't do them on someone in their 30s). Good luck.
marygreen

Hi everyone

I had a total ankle replacement 7 years ago. I was 46 years old then and had led a very active lifestyle despite 8 operations on the ankle over 20 years. The replacement was hopefully the last. However, I am experiencing lots of pain on the inside of the ankle joint. Sometimes it gives way. Does anyone know what this might be? I do have regular x-rays and had one not 4 months ago.

Is it possible for the bones around the replacement joint to fracture?

Many thanks

Mary
chyetuan

Hi marygreen,

The pain in your ankle may be due to wear and tear of your artificial joint. This can be a normal degeneration as the artificial joint's life span is about 5-10years. Similarly the ankle may give way because of loosening of the prosthesis. It is possible for bones around the replacement to fracture but i'm not sure if it is related to your giving way or is the cause of your pain. An xray will show fractures. Best to consult your surgeon about it.

cheers

chye tuan
mavisneo

Hi, I am Mavis from Spire Research and Consulting. As I am conduting a research on Orthopedic treatment in Singapore. I would like to know more about the personal experience of the Orthopedic patient. I am looking for young person (<30) who gone through knee, hip, finger, toe...etc REPLACEMENT. Incentive will be given to the suitable candidate! Please feel free to contact me for further enquiries at 63276153. Thank you. Your help is very appreciated.
Dina Sargent

Hi Mavis,
I am 35 and on the verge of getting ready to go for an ankle replacement. I don't know if that helps your cause or not. I am in the final stages of scheduling my proceedure.

Thanks
Karen

Hi Mavis - This would be interesting but I am 57 years old and had ankle replacement in May 2009. So I guess the age factor eliminates me. Thanks.
Cissy

Karen, I know this was written quite a while ago but I am really concerned about having ankle replacement. I was in a car accident 16 years ago and I have had many surgeries, I just want to lead a normal life and not be in pain all the time. My Dr. is at Vanderbilt Univerity Hospital in Nashville Tenn. He is really hesitant to do this surgery because it hasnt been done very much around here. What has your experiance been like?
mavisneo

Hi Karen, can I check with you. Are you fully recover from your ankle problem? Do you have any walking problem? Is there anyone who accompany you to the medical centre or clinic for your ankle's therapy or further treatment for your walking problem? Thank you for your information. Please feel free to contact me at 63276153.
Karen

Hi Mavis-I am not fully recovered yet. The Dr. did tell me that it would take up to one year for a full recovery. But I am walking now. I have a small brase that I wear, I can walk without it but it feels better with it. I was able to drive after three months but my husband did go with me to the dr. for check-ups. I go again the last of this month. I went to therapy a few times but now I do it on my own. Let me know if I can help in any way.
mavisneo

Hi, can we have a face to face interview with you at 1230pm tomorrow? Please send me your name, email address, contact number and home address (as we will post a cheque to you). I will send you the interview details to your email address (I cannot reveal the details in the public posting). Please email me as soon as possible as I need your confirmation. Thank you so much for you assistance and help.
Karen

Hi Mavis, So sorry but I had to check this out first. Now I realize that we are in different countries and that was puzzling me about how we would arrange an interview so quickly and I couldn't figure out the phone number. I am so sorry and if I can assist you in any way please let me know.
peteryeend

HI karen,
I am looking at having the ankle replacement done and are looking for a surgeon. Were you happy with your surgeon? Did you have any issues? If so could advise me of the hospital and surgeon who did your operation.
Thanks,
Peter
Karen Stogsdill

Hi Peter,
Yes, I was pretty happy with my surgeon. His name is Dr. Jean Maurice Page. He is originally from Canada and has done quite a few ankle replacements. His office is Cumberland Orthopaedic & Sports Medicine in London, Kentucky. I had my surgery at Baptist Regional Medical Center in Corbin, Kentucky. I had my last check-up with him November 24 and I'm doing good. I still have a slight limp but I'm trying work on that myself. I'm glad I had the ankle replacement but it was a really painful surgery the first 3 days.
Well, good luck with your surgery. And if have anymore questions let me know.
Thanks, Karen
mavisneo

Yes. Do you know anyone who gone through any replacement?
iamlucky

I had a total ankle replacement in April of 2009. I also just had my second spinal fusion of the L4,L5, and S1 region.

I have had numerous surgeries on every joint in my body, but have only had one break, and that just happened to be the most severe break on the most load bearing/smallest surface of the body.

Anyone with some questions, or some optimistic experiences, please feel free to reply.

thank you,

Regina, SK, Canada
Karen Stogsdill

I had ankle replacement on May 11, 2009. At 6 weeks I was suppose to be able to put 50% weight on with air cast on. How can I judge 50%. I have been going to theraphy once a week but the therapist says he hasn't had much experience with ankle replacement. I go back to the dr. for a check-up on July 7, 2009. This week I have had a lot of redness when I let my foot hang down and am having some pain where the plate is. I may have up and about more than usual. I tried calling the dr. today but they didn't return my call. My problem is that at this point I don't know how my ankle should be feeling. I thought I would be walking by 8 weeks. Any information would be appreciated.
mavisneo

Hi, I am Mavis from Spire Research and Consulting. As I am conduting a research on Orthopedic treatment in Singapore. I would like to know more about the personal experience of the Orthopedic patient. I am looking for young person (<30) who gone through knee, hip, finger, toe, ankle...etc REPLACEMENT. Incentive will be given to the suitable candidate! Please feel free to contact me for further enquiries at 63276153. Thank you. Your help is very appreciated.
chyetuan

You can measure 50% of body weight by using a weighing machine and get a feel of how 50% of your body weight is when you put weight through it. You should feel a similar loading on the same leg during your weight bearing activities like standing and walking.

You should try to keep your leg up when ever you are rested to ease the swelling. Twiddling your toes will also help with circulation.

Your progress will depend on the type of implant and the surgical technique used by your surgeon. He is the best person to ask regarding your recovery rate.

Do not be too disappointed if you are not able to walk by 8 weeks. Recovery rate differs between individuals. Your physiotherapist should be gradually progressing your treatment and exercises to allow you to walk better.
karen Stogsdill

Thanks. I went to the dr. yesterday and he said my progress is good. I will be walking in a month. He recommended compression hose for the swelling. I am doing much better. Just wish there were more patient stories on the web about ankle replacement. No one talks about the how it feels. I know there are no people that experience the same things. My Dr. actually explained about all the sensations that I was feeling in my ankle to me yesterday.
Beth

Hi Karen,

My father just had an ankle replacement last Monday, May 17th, 2010. He's having some swelling. I was wondering if I could ask you a few questions. His doctor never calls back! Just about what you went through and if the symptoms are the same. I would truly appreciate it.
Like, was your cast so heavy it was hard to lift? Did you get any swelling in the other(good) foot?
Thanks so much!
Beth

harbcrftco375th@aol.com
Karen

Hi Beth,
I think the swelling your father is experiencing is very normal. I went through the same thing and even now over a year later it still swells. And yes the cast was very heavy at times. After a few weeks they put a boot cast on me that was removeable and the doctor didn't tell me that I could take it off at night so I slept with it on for about 2 or 3 weeks, boy that was sure uncomfortable. But all said, I'm glad I had the surgery because I am much better now than I was before. If I can answer anymore questions just let know because it is very frustrating not knowing if what you're going through is normal or not. Karen
loristewart

Hi Karen, I hope you are doing much better at this point. I,too, am considering a total ankle replacement and have an appt. in August. My ankle is a different story than yours, however, recovery periods are different for everyone. My ankle was fused 9yrs. ago. At that time, they had no suitable replacements for someone as active as I am, so Ankle Fusion was the only option. I am hear to say,yes,after 4months of being in a cast, the ankle finally did not hurt anymore. Now after almost 10yrs, the rest of my foot is breaking down. So I am considering a S.T.A.R. replacement. Is this what they did for you? Any information You could share would be greatly appreciated. Thank You , Lori
karen Stogsdill

Hi Lori, I seem to be doing much better. I saw the dr. on July 7th and he said everything looked good. He wants to see me in September and says I should be walking without crutches or a cane. I am walking 50% weight bearing with my air cast boot on. I don't have the horrible pain like I had before surgery, but my ankle has some weird sensations in it. I am feeling a little scared about putting full weight on it when the time comes. This is the replacement ankle that I had http://www.myanklereplacement.com/DePuy/docs/Ankle/Products/replc_implants.html. Let me know if you have any more questions. Good luck!
loristewart

Hi Karen, Thank you so much for the information, I am very grateful for any and all information. Before I had the Fusion performed, I researched Doctor's, hospitals, and success rates. Even though I had done all the research, the doctor I selected, did it wrong! Fused at the wrong angle...not good! I spent 4months in a non-weight bearing cast to be out of the cast for approximently 1month and had to have the ankle re-broke and fused over again! I additionally spent another 4months in a cast. Needless to say I became very proficient on crutches! Now I'm looking at T.A.R. so I can have mobility back in the ankle. Fusions can be extremely hard on the other bones and joints in the foot. A lot of the sensation your experiencing will subside in time,but don't discouraged, in the long you will be elated to not be in pain. Best of luck to You and again Thank You, Lori
karen Stogsdill

Lori, sounds like you have been through so much with your ankle already. I was in an auto accident years ago and my ankle was completely dislocated with the ankle bone coming through the skin. I never had much trouble with it until about 5 years ago. Then it got so bad I could hardly walk and sometimes I would fall. I checked with a couple of Doctor's and they encouraged me to get an ankle fusion but I didn't want that, so the one I was seeing on a regular basis referred me to his partner and he said I was a good candidate for ankle replacement. The Doctor that did mine had done about 15 or 16 replacements, he is from Canada and from the research that I did he seemed to be good at it. Please keep me posted on your progress when you have your surgery. I pray that everything goes well for you!
loristewart

Hi Karen, I'm sorry I haven't been on line in almost 2wks! I have a 2yr old
daughter,so sometimes makes it difficult to take time.My appt. is today for
a consultation regarding the replacement. Yes,my ankle too, was the result
of a car accident.It was broken in 15 places with the lower leg bones going
through the ankle joint and coming through the bottom of the foot. I also
suffered a posterior tibial tendon rupture,which was replaced with some
artificial material. They did repair and after about 9months in a non-weight
bearing cast, I started the 3yr long road to physical therapy. This repair
lasted about 10yrs.I train in TaeKwonDo, so I definately pounded on that
foot for an additional 10yrs before it broke down. At that time,and still, I
am not willing to give up Martial Arts, so the only available fix, was
fusion.They have made incredible strides at providing an impact-bearing
TAR,and that is why I'm doing my best to stay on top of it! I so appreciate
you keeping me informed and letting me in on your progress! I hope you
are,each day, doing better.It does take a long time,as it is the most
intriguing joint in entire body,and the toughest to duplicate.Stay
strong,and still,best of luck. Thank you,Lori
karen Stogsdill

Hi Lori, Wow, you do have your hands full! I do pray that your appt. today is a positive one. Sometimes I feel like I am the only one in the world with this ankle problem, when people ask me what happened to me they say they have never heard of ankle replacement. I took a fall last Thursday and had to go for exrays but everything was fine. Actuallly, I am supposed to walk without crutches next week with the air cast on. We'll see how that goes. I am very familiar with TaeKwonDo. Both of my sons were in that. One is 3rd degree blackbelt and the other 2nd degree. Again, I hope everything goes well today for you.
Karen
loristewart

Hi Karen, Well I guess I'm not a candidate for an ankle replacement at this
time. The Doctor said I would probably blow through it in about a year! He
believes that I'm still too active. Curious...What does your Doctor say
about activity? I still train in TKD, and am not willing to give it up. How
exciting for your sons! It is a terrific Art. I will be eligible next year
to test for 6th degree. I also walk about 2-3miles per day.Plus he also said
that with a toddler, it adds extra pressure on that replacement. He wants to
manage the other problems with my foot instead. He injected it with
cortisone and prescribed an orthodic for the shoe. I am very interested to
follow your progress and I appreciate the info more than you know. I think
alot of people suffer ankle injuries, however, yours and mine were
absolutely not just an injury. It is very tramatic to experience what we
went through. What the Doctor actually said after looking at my x-rays was,
I now have Sub-Tayler Osteoarthritis! Who knew, I thought when it was fused,
there would no longer be arthritis.Oh well, let me know, if possible, what
your Doctor says about activity. And as always, best of luck with your new
ankle. Please don't get discouraged, remember, perfection takes time! Lori
karen Stogsdill

Hi Lori, I was hoping to hear good news concerning your ankle replacement. I'm so sorry! I guess with fushion you still have the joint but you're not suppose to have the pain. I was always a very active person but had slowed down a lot before surgery. My ankle hurt so bad before that I could barely walk some days. I lost my job in Febuary of this year so that really slowed me down, that's why I decided just to go ahead and have my surgery while I still had insurance. My doctor did tell me no running or jumping. But, I am 57 years old, I think that's one of the reasons that I was a good candidate for the surgery. I also like to walk and hope to be able to do that again. I do all of our yard work, push mower and all. My doctor said I should be able to do all that again. My husband is disabled from a car wreck also. Sounds like you really have a passion for TKD. That is a very strenuous activity for someone with ankle problems. Several years ago my oldest son sprained his ankle so bad that we thought it was broke when he was doing TKD. I notice now sometimes he limps from it.
I reallly appreciate hearing from you and hope you the best of recovery. Hang in there, there is new medical technology everyday! karen