Ankle Replacement Surgery

What is a total ankle replacement?

A total ankle replacement is a procedure in which the surgeon removes an injured ankle joint and replaces it with a plastic and metal joint.

When is it used?

The procedure may be done when the ankle joint is painful and is no longer working well, especially because of rheumatoid arthritis or trauma-related arthritis. Trauma-related arthritis can happen when the joint is injured by fracture, dislocation, or damage to the ligaments around the joint. Osteoarthritis is rarely a reason to do ankle replacement.

Alternatives to this procedure include:

• taking acetaminophen, aspirin, or other medicine for pain and inflammation
• limiting your activity and using a walking aid, such as a cane or walker
• wearing an ankle brace
• making changes to your shoes to help you walk
• using ice or heat to reduce pain and swelling.
• having surgery to fuse the ankle joint.

Ask your healthcare provider whether any of these choices would be of benefit to you.

How do I prepare for a total ankle replacement?

Because you may need blood transfusions during the operation or during recovery, you may want to donate some of your own blood before the procedure. Blood should be donated within 4 weeks of the procedure.

Plan for your care and recovery after the operation, especially if you are going to have general anesthesia. 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 your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. 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 will be given general, spinal, or epidural anesthesia. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation. An epidural or spinal anesthetic blocks pain in the lower part of your body. It should keep you from feeling pain during the operation.

The surgeon will make a cut over your ankle and expose the ankle joint. Your surgeon will move the tendons aside and separate the leg bones (tibia and fibula) from the third ankle bone (talus). The surgeon will remove the joint surfaces of the leg and ankle bone and attach the artificial replacement to the leg and ankle. The surgeon will then put the tendons back in place. She or he may place drains in the cut to drain any blood and then close the cut with stitches or staples.

What happens after the procedure?

You may be in the hospital for 1 to 4 days, depending on how fast you heal. The ankle may be in a splint or cast to keep it stable. You may need blood transfusions. You may be given medicine to prevent a blood clot to the lungs and to prevent swelling. You may need physical therapy.

You will not be able to put weight on your ankle for the first 6 weeks. During this time you will be using crutches or a walker. Before you leave the hospital you will be shown how to take the splint off twice a day so you can do range-of-motion exercises. Your healthcare provider will remove the stitches or staples about 2 weeks after surgery. Ask your healthcare provider for other guidelines and when you should come back for a checkup.

Let your dentist and healthcare providers know that you have an artificial joint. If you have a dental infection or skin infection, you may need to start antibiotics right away. If you have a condition such as diabetes that puts you at higher risk for infection, you may need to take antibiotics before dental procedures or some kinds of surgery. For simple dental and surgical procedures, most people with replacement joints do not need to take antibiotics in advance, but you should check with your provider about this.

What are the benefits of this procedure?

You will be able to move your ankle more easily and fully and less painfully. It will be easier for you to walk, and you may no longer need to use a cane or walker.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• If you have an epidural or spinal anesthetic, it may not numb the area quite enough and you may feel some discomfort. Also, in rare cases, you may have an allergic reaction to the drug used for this type of anesthesia.
• Other bones may break during the surgery.
• Nearby tendons may be cut, requiring a longer hospital stay.
• Nearby arteries or nerves may be damaged or cut.
• Swelling or pressure from the procedure may injure the nerves in the ankle and cause some numbness. Your healthcare provider may give you medicine to try to avoid this problem.
• Rarely, you may get a blood-borne disease from a blood transfusion of another person's blood.
• The new ankle joint will not move as well, or be as strong, as a perfectly normal joint.
• You may have infection or bleeding.
• The new joint can be dislocated rather easily.
• The replacement parts may loosen or break.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever.
• You have uncontrollable pain.
• You become short of breath or cough up blood.
• You have foul-smelling drainage from the surgical wound.
• Your ankle has unusual warmth, redness, or swelling.
• You have chest pain.

Call during office hours if:

• You cannot do the physical therapy.
• You have questions about the procedure or its result.
• You want to make another appointment.