What is Ankle Replacement Surgery?

J.M. Willhite

Ankle replacement surgery, also known as ankle arthroplasty, is a procedure that may be conducted when one or more of the bones in the ankle joint have been damaged. Usually conducted under general anesthesia, the procedure may be performed in the presence of severe damage where the use of prosthetics may be necessary. As with any surgical procedure, ankle replacement surgery does carry certain risks and these should be discussed with a qualified health care provider prior to pursuing this treatment option.

A scalpel is a small, sharp knife that is used in surgeries to make incisions.
A scalpel is a small, sharp knife that is used in surgeries to make incisions.

Ankle arthroplasty may be a necessary avenue for individuals who have sustained moderate to severe damage to their ankle. Individuals who experience chronic pain or have lost ankle joint function may pursue ankle replacement surgery to restore function to the damaged joint. Those who have been diagnosed with inflammatory conditions that adversely affect the joints and mobility, such as osteoarthritis or rheumatoid arthritis, may develop ankle joint issues that only replacement surgery may remedy. Additionally, ankle arthroplasty may be recommended for people who have sustained a bone fracture that compromises ankle joint function.

Ankle replacement surgery may be needed if a patient has one or more ankle bones that are damaged.
Ankle replacement surgery may be needed if a patient has one or more ankle bones that are damaged.

Prior to the start of the procedure, the patient may be given a spinal block and mild sedative or placed under general anesthesia; the approach is dependent on several factors, including the anticipated extent of the surgery. Conducted as an open procedure, an incision is made on the front portion of the ankle to easily access the ankle joint. In order to prep the area for necessary repair, the blood vessels, nerves and tendons are repositioned to allow access to the damaged bone or bones.

The actual replacement procedure necessitates the removal of the damaged bone. Affecting bones in the lower leg, such as the fibula and tibia, and a portion of the foot bone, a reshaping of the remaining bones must be performed to accommodate the artificial joint, known as a prosthetic. Once the remaining bones have been prepped, the artificial parts of the prosthetic are positioned and may be held in place with a special type of glue. Supportive instrumentation, such as screws, may be utilized to stabilize and reinforce the prosthetic. After a bone graft is performed between the bones of the lower leg, the blood vessels, tendons and nerves are repositioned and the wound is closed with sutures.

Individuals scheduled for ankle replacement surgery may be instructed to temporarily discontinue their use of any medications that may interfere with blood clotting. Prior to surgery, the individual may be instructed to not consume any food or beverage at least six hours prior to the procedure. For up to three days following surgery, a small catheter may be positioned to drain fluid and blood from the joint. It may be recommended that the individual keep his or her leg elevated to prevent excessive swelling. The individual may remain hospitalized for up to one week, during which time physical therapy may also be initiated.

The prognosis associated with ankle replacement surgery is generally good and mainly dependent on the individual’s overall health, activity level, and the extent of damage to the joint prior to surgery. In most cases, ankle joint replacements last for a decade or more and enable the recipient to remain physically active without pain or discomfort. Risks associated with this surgical procedure may include infection, blood clots, and excessive bleeding. Use of general anesthesia carries a risk for breathing difficulty and allergic reaction to medications administered. Risks specific to ankle replacement surgery may include nerve damage, weakness or instability of the ankle joint, and displacement or failure of the prosthetic.

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