Ankle Replacement (Ankle Arthroplasty)

Foot

Total ankle replacement, also known as total ankle arthroplasty, is a surgical treatment for ankle arthritis that is appropriate for some patients.
 

Can ankles be replaced?

Ankle replacement surgery has been an option for many years. Recent advancements in technology and techniques have made it the preferred option for treating patients with ankle arthritis.

Ankle replacement can take away the pain from the arthritis and preserve the motion at the joint. This helps patients perform tasks such as walking on uneven ground and going up and down stairs. It also protects the other joints of the foot to help prevent them from getting arthritis.

 

What is ankle replacement surgery?

Ankle replacement is a surgical treatment for ankle arthritis in which portions bone and cartilage in joint removed and replaced with prosthetic implants. A total ankle replacement prosthesis is made up of three different parts: A titanium metal component is attached to the tibia, a cobalt-chrome piece is connected to the talus, and a polyethylene (plastic) implant is placed between the two. An ankle replacement takes away pain from arthritis, while also preserving motion at the joint.
 

What happens if I have avascular necrosis of the talus?

In some cases, part of the talus loses its blood supply and collapses (called avascular necrosis, "AVN" or osteonecrosis). When this happens, the bone is no longer healthy and cannot support an ankle replacement. But there are additional options, depending on how much of the bone is necrotic.

If the area of necrosis is small, then that portion of bone can be removed at the time of the replacement, and the implant can rest on the remainder of the talus that is still healthy.

If the area of necrosis is too large, then the entire talus bone can be replaced with a metal piece that is custom made for the patient.

 

Who should get an ankle replacement?

Ankle replacement is for patients who are no longer able to manage their ankle arthritis pain and swelling with nonsurgical treatments such as:

• physical therapy
• ankle braces
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroid injections
  
   

Should I get an ankle replacement or an ankle fusion?

Studies have shown that replacement and fusion offer the same degree of pain relief, but that ankle replacement provides much better function in the ankle by retaining the joint’s flexibility. But in some patients, ankle replacement is not possible, and fusion is the appropriate option.
Before ankle replacement gained acceptance, ankle fusion surgery was the standard treatment for ankle arthritis. In an ankle fusion, the two bones of the ankle, the tibia and the talus, are joined together and held in place with plates and/or screws. Over time, the bones heal together. Once that occurs, the joint will no longer hurt, but will also no longer bend.
 

When is ankle fusion a better option than ankle replacement?

There are a variety of reasons why some patients may not be able to have an ankle replacement. It could be that their bone that is too weak, or that they have a deformity or malalignment of the ankle and foot that is not correctable. Replacement is not appropriate for people with certain neuromuscular disorders or those who have Charcot arthropathy – a peripheral neuropathy (loss of sensation) in the foot and ankle. In addition, patients with an active infection are not candidates for ankle replacement and are best treated with a fusion.
 

Why is ankle replacement a better option now than years ago?

Total ankle implants are more anatomic now than years ago. This means that they restore the normal anatomy of the ankle and require that only minimal bone tissue be removed from the ankle. Instruments to perform the surgery have also significantly improved, allowing orthopedic surgeons to be more accurate and perform the surgery more reliably. There has also been significant progress in the medical community’s understanding of how to balance the ligaments of the ankle and align the foot underneath the ankle at the time of ankle replacement. All of these factors have resulted in better outcomes for patients who receive an ankle replacement.