Ankle replacement surgery, or ankle arthroplasty, is the surgical replacement of an arthritic or damaged ankle joint with a prosthetic joint. Arthritis, a joint inflammation that can cause pain and stiffness in any joint in the body, is quite common in the small joints of the foot and ankle. There are more than 100 forms of arthritis. All types can make it difficult to walk and perform activities you enjoy.
Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.
Although ankle replacement surgery has been available for more than 30 years, many people have not even heard of the procedure. Most of us know someone who has had a knee or hip replacement, but the ankle is less likely to become arthritic than the hip or knee. Ankle surgery is therefore much less common, and fewer prosthetic implants have been perfected. However, the FDA recently approved several new implant designs, and orthopedic surgeons have refined surgical techniques. Consequently, outcomes have improved, with patients enjoying a greater degree of mobility and activity than in years past. As a result, the number of ankle replacements being performed is increasing dramatically.
Arthritis of the Ankle
The ankle joint, or tibiotalar joint, is made up of the two lower leg bones (tibia and fibula) and the first bone in the foot, called the talus. This joint can lose its cartilage covering through injury, infection, or simple wear and tear, leading to arthritis of the ankle. The first step to managing ankle arthritis is to consult an orthopedic foot and ankle surgeon. Our surgeons always begin treatment with the least invasive options. These might include:
- Suggesting wearing supportive shoes and avoiding activities that trigger ankle discomfort
- Physical therapy
- Using a cane
- Suggesting over the counter pain medication
- Prescribing muscle relaxants
- Bracing the ankle with an ankle lacer, a supportive device that fits inside the shoe and laces up like an old-fashioned boot
- Suggesting use of an Ankle Foot Orthosis or AFO, a plastic brace that goes along the back of the leg and the underside of the foot, and fits inside the shoe
- Steroid injections in the ankle joint
When ankle pain interferes with daily activities and can no longer be controlled by bracing or medication, surgery is a viable option. Total ankle replacement can be transformative for patients with severe osteoarthritis, or rheumatoid arthritis. However, not everyone is a good candidate for total ankle replacement. Your doctor will have to consider your medical history, lifestyle, goals, and overall health before making a recommendation.
There are two surgical approaches to treating a severely arthritic ankle:
- Arthrodesis, or ankle fusion, is a procedure that permanently fixes the talus to the end of the leg bone. This procedure has long been the gold standard for surgically treating end stage ankle arthritis, but this is changing with the development of improved implants and surgical techniques. However, certain severe deformities are still more effectively treated by fusion rather than replacement
The surgeon removes damaged cartilage and any diseased bone from the ankle joint. The joint surfaces are then compressed together and fixed with screws to create one bone. Typically the tibia is fused to the talus, but some surgeons prefer a procedure that also involves the fibula. After fusion, the foot generally retains 15 degrees of motion at the most. While this procedure relieves pain, it sacrifices a lot of joint mobility. Arthrodesis is generally reserved for patients with severe rheumatoid arthritis or varus/valgus deformities of the foot and/or ankle.
- Arthroplasty, or total ankle replacement, is usually the preferred alternative to ankle fusion. Not only does this procedure relieve the pain of ankle arthritis, it preserves the motion of the ankle joint. The damaged bone and cartilage are removed and replaced with a prosthetic ankle joint. Depending on the type of implant being used, ankle replacement surgery can be performed either from the front or the side. If a patient has a tight calf muscle or Achilles tendon, it may be necessary to surgically lengthen the tendon to maximize range of motion. Our surgeons can determine in advance whether this needs to be done.
Other Ankle Surgeries
Bunion operative correction Also known as exostectomy or bunionectomy, this procedure involves the removal of bone from the end of the first metatarsal bone, which joins to the base of the big toe. In order to bring the big toe back to its correct position, the surgeon may have to realign bone, ligaments, tendons, and nerves. While bunion surgery reduces foot pain and makes it easier to participate in everyday activities, recovery can take as long as 6 months.
Ankle arthroscopy This minimally invasive surgical procedure involves the use of a fiber-optic viewing camera and tiny surgical tools to operate on the ankle through small incisions. The miniature optic camera magnifies and transmits images of the ankle to a video screen. Ankle arthroscopy is performed for the surgical evaluation and treatment of a variety of ankle conditions, including certain fractures, ankle impingement, and arthrofibrosis (scar tissue).
Ankle ligament reconstruction Ligaments connect bones to each other and support the joints. Bad sprains and chronic ankle instability may require ankle ligament reconstruction when ligaments stretch out and become too loose. Several different techniques are utilized depending on the individual case. It may be possible to repair patient’s existing ligaments with stitches. In other cases, a tendon can be used to replace the torn ligaments.
Foot & Ankle tendon repair & reconstruction Tendons are thin bands that attach your muscles to your bones. A joint injury may result in tendons stretching , tearing partially, or even completely. Depending on the extent of the injury, the surgeon may sew the torn ends of the tendon together or perform a tendon graft using a piece of tendon from another part of the body.
Flatfoot & cavus foot reconstruction Flatfoot and cavus are two different structural abnormalities of the foot. In flatfoot, the arch is flattened, causing alignment problems that lead to hip, ankle, and knee pain during standing and walking. Surgical correction of the foot improves alignment. A combination of surgical procedures may be used to reconstruct a flatfoot, some to correct bone deformities and others to repair ligaments and tendons. A cavus foot has an excessively high arch. This may be due to injury or a variety of deformities, such as clubfoot. The goal of surgery is to reduce pain and improve function. The procedure may involve correcting both the bony deformity and the accompanying muscle imbalances.
Foot & ankle trauma Emergency surgery for foot and ankle trauma addresses breaks or fractures of the foot and ankle, tendon ruptures, and other serious injuries.
Achilles repair & reconstruction A ruptured Achilles tendon is a relatively common sports injury. If the tendon has been torn in two, reconstructive surgery should be scheduled as soon as possible. The procedure is performed through several incisions in the back of the heel.
Foot & ankle cartilage repair Advanced arthritis of the ankle can be very painful and debilitating. Cortisone shots and ankle braces may provide temporary relief, but if the pain persists, surgery is the next step. The specific surgical procedure depends on where the arthritis is located. Bone spurs may need to be arthroscopically removed from the ankle joint. If the talus bone of the ankle is involved, damage may only be to the cartilage surface or also involve the underlying bone. First, damaged bone and cartilage are removed from the surface of the talus bone. The surgeon then drills small holes into the surface of the bone to provide channels for healthier bone to grow and produce fibrocartilage, a cartilage- like scar tissue that protects the ankle joint.
Meet Our Specialists
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