Benefits of ankle replacement surgery

If you have advanced ankle arthritis, ankle replacement surgery can help relieve discomfort without compromising mobility.

Most people are familiar with knee and hip replacements, but you may not be as familiar with ankle replacement surgery. That may be because it's not as common as its counterparts. However, in recent years, ankle replacement procedures have increased greatly in the United States.

What is ankle replacement surgery?

Also known as total ankle arthroplasty, or TAA, total ankle replacement is a surgery that replaces damaged portions of the ankle with prosthetics. A prosthesis for total ankle replacement consists of three parts:

• A titanium metal component attached to the shinbone (tibia)
• A cobalt chrome component attached to the bone that connects your leg to your foot (talus)
• A plastic implant placed between these two parts

One of the benefits of ankle replacement is that you retain most, if not all, of your ankle's range of motion, explains Dr. Gary Schmidt, a foot and ankle orthopedic surgeon with OrthoONE at Swedish Medical Center in Englewood, Colorado – part of our larger HCA Healthcare network. Ankle replacement also protects the joints around the ankle from wear.

"Ankle replacement is excellent as far as pain relief goes and as far as maintaining your mobility and activity levels," Dr. Schmidt says.

What does ankle replacement surgery entail?

Like other total joint surgeries, ankle replacement is mostly done on an outpatient basis. Providers take scans beforehand to reduce the amount of time spent in surgery. The procedure itself takes about 45 minutes to one hour, explains Dr. Schmidt, and it's performed under tourniquet control to minimize blood loss.

"Some patients will have surgical pain afterward but notice almost immediately that the arthritic pain is gone," he says. "If your wound looks good, we'll start your therapy and weight-bearing at two weeks."

After the procedure is finished, the surgeon will put a dressing on the wound. "We want you to start moving it on day one, and we want you to start walking on it at two weeks," Dr. Schmidt explains. That said, an ankle replacement is smaller than a knee or a hip implant, so it takes a lot more stress. This is why it's important to ensure the wound heals properly first.

When is ankle fusion a better option?

Ankle replacement has become the gold standard for curing ankle arthritis, but this wasn't always the case. Ankle fusion used to be the treatment of choice, and it's still used to manage certain ankle issues. Unlike ankle replacement, ankle fusion involves fusing the ankle bones together using plates or screws. While this method relieves pain, it limits the ankle's range of motion.

However, not all patients with ankle issues need a replacement, explains Dr. Schmidt. You have a few factors to consider when deciding which procedure is right for you.

"People in their 20s or early 30s who have arthritic troubles that are secondary to previously serious ankle injuries lean a bit more toward fusion," Dr. Schmidt says. People who have severe deformities may also be better candidates for ankle fusion. "Patients with neuropathy, such as with people with diabetes who have severe deformity with arthritis, aren't candidates for replacement. But they do very well with fusions."

Ankle replacements are usually performed on patients in their 50s and 60s, although older people can get a replacement if they're healthy. "It's not numerical, it's physiological," says Dr. Schmidt.

Younger people can be candidates for ankle replacements but generally on a case-by-case basis. With replacement surgery, the patient needs to have enough bone left to allow for the replacement to be taken out and replaced in the future.

What is the long-term outlook for ankle replacement?

A common question with any type of joint replacement is how long it lasts. Here's where there can be some confusion. Dr. Schmidt explains that joint replacements are studied in 10-year intervals, which means looking at how many implants are still good in 10 years.

"The data on ankle replacements is as good as knees and hips. Roughly 90% to 95% of ankle replacements are fine after 10 years," says Dr. Schmidt. The percentage drops a little after that, but at least 80% of replacements are still good after 20 years.

While they might not be as well known as hip and knee replacements, ankle replacements can be beneficial for people with advanced ankle arthritis. Thanks to advancements in technology, the surgery is highly successful. If you think you might benefit from ankle replacement surgery, talk to your doctor to learn more.