When Tim, a patient in his fifties, came to see me, he had been suffering from ankle pain for years. Severe arthritis made it increasingly difficult for him to do basic chores like mowing the lawn, let alone athletic activities that he once enjoyed. When the pain became almost constant, even when he was resting, he decided to consider ankle replacement surgery.
While most people have heard of knee and hip replacement for debilitating arthritis in these joints, many patients with severe ankle pain are surprised to learn that total ankle replacement may be an option.
Although ankle fusion traditionally has been a more common treatment, improvements in implant design and technique have made ankle replacement a viable alternative for many patients. While the goal of both procedures is to eliminate pain, ankle replacement allows for better movement after surgery.
Who Develops Ankle Arthritis?
While knee and hip arthritis generally result from years of wear and tear on a joint, ankle arthritis is usually caused by an old injury such as a broken ankle or multiple ankle sprains. Many patients I see sustained an ankle injury two to three decades earlier. Arthritis takes years to develop, and the pain tends to get worse and worse as time goes on.
What Does Ankle Replacement Entail?
Ankle replacement surgery entails replacing parts of the arthritic or damaged joint with an implant made of metal and plastic. Since the artificial joint is designed to replicate the movement of a healthy joint, it provides patients with much better motion and mobility compared to ankle fusion. When bones in the ankle are fused together using metal screws, movement in this area is restricted. This in turn puts stress on other joints in the foot, leaving an individual more susceptible to developing arthritis in those joints.
Candidates for Ankle Replacement
Candidates for ankle replacement are people with severe pain for whom conservative treatments, such as rest, activity modification, pain medication and an ankle brace fail to provide relief. Eligible patients commonly are at least 55 years old, they must have good bone quality, and they cannot have any underlying health problems that would impede healing. However, every patient is different.
Ankle replacement is highly successful in eliminating pain, and ankle motion after surgery is similar to what patients were experiencing before the procedure. Once recovery is complete, they can usually get back to many activities they gave up due to arthritis, such as walking, swimming, riding a bicycle and traveling. Patients are advised to avoid high impact activities such as running and jumping, which put stress on the joint and may decrease how long it will last. Early studies have found that a high percentage of patients still have the implant after 10 years.
Recovery after Ankle Replacement
Patients should be prepared for a lengthy recovery, but most will tell you that for the pain relief they received, it was well worth it. They generally spend one or two nights in the hospital and won’t be able to put weight on their foot for four to six weeks following surgery. When patients are able to gradually start bearing weight, they typically use a special walking boot for another six weeks. They also begin physical therapy, which usually lasts three or four months.
Full recovery from ankle replacement surgery and the resumption of certain activities may take up to a year, but most patients are doing very well even by three months.
Ankle replacement is a complex procedure, and increasing numbers of orthopedic surgeons are receiving the training necessary to perform it. Patients are advised to choose an experienced orthopedic surgeon specializing in foot and ankle surgery. Studies also show that selecting a surgeon who does a high volume of total ankle replacements gives patients the best chance for a good result.
Dr. Scott Ellis is an orthopedic surgeon, fellowship trained in foot and ankle surgery and has vast experience with a variety of foot and ankle problems and injuries.