A total ankle replacement, also known as total ankle arthroplasty, is exactly what it sounds like; the replacement of a damaged ankle joint with an artificial ankle joint. This ankle procedure is performed to alleviate pain, restore range of motion and prevent increased stress on other areas of the body.
The word “arthroplasty” comes from the Greek arthron, which refers to the joints in the body and plastos, meaning formed or molded. So, arthroplasty literally means to form or mold the joint. In this case, total ankle arthroplasty means to mold or form an ankle joint to replace the natural one that has become damaged.
Ankle Anatomy
The human ankle is one of the body’s larger joints and is composed of three bones that come together and act as a hinge. These bones are the lower portion of the tibia, commonly referred to as the shinbone, and the fibula, which is a small bone, also located in the lower leg. The ends of the tibia and fibula meet to form a socket, and this is where the third bone, the talus, completes the joint. The talus, which is the foot bone that sits right above the heel bone (calcaneus), fits inside the socket. This socket is then bound together and protected by a series of ligaments and tendons.
When healthy, the bones, ligaments and tendons of the ankle, in coordination with associated muscles and nerves, allow a wide range of flexibility. The ankle joint facilitates the movement of the foot away from the body (plantar flexion) and movement toward the body (dorsiflexion). It also enables movement from side to side, as well as the ability to make a twisting motion.
Conditions Leading to the Need for Total Ankle Replacement
Due to the complexity of its makeup, which is responsible for the foot’s wide range of motion, and because it is one of the weight-bearing joints, the ankle is very susceptible to injury. Fractures, even those that healed completely, very often lead to the development of post-traumatic arthritis later in life. Joints also simply wear out with age, resulting in the same degenerative damage to the ankle as is commonly seen in the knee and hip joints.
Whether from trauma or the natural wearing away that comes with aging, the damage to the ankle joint will get worse with time. This can have a significant effect on quality of life, as the pain, stiffness and swelling eventually result in the loss of function in the ankle. Conservative treatments, such as reduced activity, bracing, special inserts, shoe modifications, physical therapy, anti-inflammatory medications and cortisone injections will initially be suggested. If these prove ineffective, ankle replacement surgery will likely be recommended as the best treatment option.
Total Ankle Replacement Surgery
Once the decision has been made for replacing the ankle joint, a customized plan will first be developed using computer imaging and a CT (computerized tomography) scan, which is a series of x-rays that provides cross-sectional images of all of the parts of the ankle. This is commonly done using the Wright Infinity and Inbone Total Ankle Systems, which utilize the Prophecy Preoperative Navigation Guides.
Prior to the surgery, Wright’s technology creates a unique model of the patient’s ankle and a simulation of the procedure. It also recommends size, placement and alignment of the implant based on this modeling.
The patient will be under general anesthesia for the surgery. An incision is made along the front of the ankle so that the damaged bone and other tissue can be removed. Based on the pre-surgery modeling, the artificial joint, made of metal or plastic, will be inserted and aligned. It will then be secured to the surrounding bones of the leg and foot, and the incision will be closed.
Following total ankle replacement surgery, the patient will remain in the hospital for a short stay. Pain medication will help to reduce discomfort. The patient will be sent home with their ankle splinted or in a cast and will be non weight bearing.
Recovery Following Total Ankle Replacement
Once any discomfort from the procedure itself has passed, most patients are immediately aware of significant relief from the pain they were experiencing prior to the joint replacement surgery. Even before the ankle has totally healed, there will also usually be a dramatic improvement in range of motion and movement.
It will be important to follow all post-operative instructions, especially those pertaining to physical therapy, which is an essential part of recovery following any type of joint replacement surgery. As soon as there has been sufficient healing for the patient to be able to put weight on the ankle, it will be time to begin a structured physical therapy routine designed to strengthen muscles and restore mobility.
As previously noted, the ankle is a complex, weight-bearing joint. Restoring full function with joint replacement surgery may not always be possible. That said, many patients report a significant reduction in pain as well as a marked improvement in function. Depending on the overall health and activity level of the recipient, many total ankle replacements last 10-15 years or longer.
Contact Christopher E. Hubbard, MD Today
If you require a total ankle replacement or have any questions regarding the procedure, it is essential to consult with an experienced and knowledgeable health professional as soon as possible. Dr. Christopher Hubbard has the necessary training and skills to provide you with the best possible care. Contact our office today to schedule an appointment.