Ankle Replacement Surgery

Ankle replacement surgery is a procedure used to repair and/or replace damaged bones in the ankle joint. Before deciding on ankle replacement surgery, your orthopaedist will recommend that you try various nonsurgical treatments for several months to see if they reduce your pain and inflammation to a tolerable level. If the conservative approach fails, surgery may be the only solution for your problem.

Reasons for Ankle Replacement Surgery

Debilitating ankle injuries and diseases are the main reasons for ankle replacement surgery. The state-of-the-art procedure can relieve debilitating pain from injury or arthritis, retain movement in the ankle and improve walking ability:

  • Ankle injuries – Falling from a great height, high impact from playing sports or an automobile accident can fracture or obliterate your ankle bones and damage surrounding tissue. When ankle fusion surgery and tendon transfer surgery can't adequately repair the damage, ankle replacement surgery may be your best option.

  • Arthritis – Severe arthritis is one of the most common reasons for ankle replacement surgery. Arthritis can cause inflammation and degenerative wear and tear of the smooth, protective cartilage that covers the ends of the bones of your ankle joint and allows them to glide smoothly past each other. The cartilage becomes stiff and loses its elasticity and becomes more susceptible to damage. Over time, it may wear away in some areas and lose its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. As more cartilage wears away from the disease, the joints and surrounding bones are no longer protected or able to function easily. The bones rub against each other and become damaged from the bone-on-bone friction. Left untreated, ankle bones can crack and become so worn down that they need to be replaced. Ankle replacement surgery for severe arthritis tends to have better results than ankle fusion regarding increasing ankle function and mobility.

Ankle Replacement Surgery

Ankle replacement surgery is usually performed while you are under general anesthesia. Your orthopaedic surgeon begins by making an incision in front of the ankle to expose the joint. The tendons, nerves and blood vessels are gently moved to the side to prevent them from damage during the surgery. Your surgeon then removes the damaged bone and any bone remnants. The surgeon will reshape the three bones of your ankle — the tibia, fibula and talus bones. The tibia is at the lower end of your shin bone. The fibula is at the lower end of the smaller bone in your leg.The talus is the foot bone at the top of your foot on which the lower leg bones rest.

Once the ankle bones are reshaped, the surgeon then attaches the artificial joint to their ends. Generally made from metal and plastic parts, your new ankle joint is custom-fit and very durable. Bone cement and/or metal screws may be used to hold the fibula and tibia in place and provide further support for the ankle. A bone graft is then used to fuse the ends of the fibula and tibia to the implant. Together, these procedures create the utmost support within the structure of your ankle. The procedure is complete once the surgeon moves the tendons, nerves and blood vessels back into place and closes the area of incision with sutures.

What to Expect After Ankle Replacement Surgery

After ankle replacement surgery you will remain in the hospital for 3 to 4 days. Your ankle will be in a cast or a splint for 5 to 8 weeks, depending on the extent of your injury. The use of crutches or a wheelchair will help you stay mobile while keeping pressure off your ankle. Your doctor will recommend that you keep your ankle elevated above chest level when you are resting or sleeping. This helps keeps any swelling and pain down in the ankle.

Physical therapy is usually advised after surgery to help train you on the best ways to perform daily activities. Successful ankle replacement surgery will rid you of your pain and help you regain mobility and function in your ankle.

The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute's Foot & Ankle Services in New York performs ankle replacement surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the foot and ankle.

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