Total Ankle Replacement

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

When is it used?
The procedure, not commonly performed in this country, is indicated when the ankle joint is painful and is no longer working well. Total ankle replacement is performed almost exclusively on older people (over 60 years old) with rheumatoid arthritis. It is used when other treatments have not worked. Arthritis from other causes is rarely a reason to do ankle replacement.

Alternatives to this procedure include:

• Medical therapy
• 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 ? a more common surgical option in younger, more active patients in whom non-operative therapy has failed.
• Choosing not to have treatment, recognizing the risks of your condition.

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. 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.

Follow any instructions your doctor may give you. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?
You may receive general, spinal, or epidural anesthesia. A general anesthetic will place you in a deep sleep. It will prevent you from feeling pain during the operation. An epidural or spinal anesthetic is an injection into the spine that should keep you from feeling pain from the waist down during the operation.

The surgery is usually done with a tourniquet around the thigh to prevent blood loss during the surgery. The doctor will make a cut over your ankle and expose the ankle joint which is the joint between the leg bones (tibia and fibula) and the ankle bone (talus). The doctor will make cuts in these bones to make room for the artificial joint replacement that will be cemented into place.

What happens after the procedure?
You may be in the hospital for several days, depending on how quickly you heal. The ankle may be in a splint or cast to keep it stable. You may rarely need blood transfusions. You may be given a medication to avoid a blood clot in your legs that can go to the lungs. A period of physical therapy is often required after ankle replacement. Walking on the new ankle is often not allowed for several weeks to months, depending on the characteristic of the specific implant.

Ask your doctor for other guidelines and when you should come back for a checkup.

What are the benefits of this procedure?
The primary benefit is pain relief. You may regain use of the ankle and be able to walk without pain, help, or use of a cane or walker.

What are the risks associated with this procedure?
There are some risks when you have general anesthesia. In the elderly, mild to severe confusion can occur which may last from hours to weeks after general anesthesia. Discuss these risks with your doctor.

• 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 replacement parts may become loose or break. The risk of loosening increases with time.
• 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.
• In rare cases, you may have an allergic reaction to the drug used in spinal anesthesia that is usually considered safer than general anesthesia.
• Rarely, you may contract a blood-borne disease from a blood transfusion of another person's blood.

You should 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.