Ankle Joint Replacement

HOW DOES IT WORK?

What is an ankle joint replacement?

Ankle joint replacement is a specialised surgical procedure for the treatment of arthritis. Arthritis of the ankle joint is normally the result of ageing, the cartilage that covers your bones wears down and gradually becomes thinner and rougher. This causes the bone underneath the cartilage to thicken and it can also happen following sports injuries or also be caused by rheumatoid arthritis. Over time, wear to the cartilage and bone ends causes pain and swelling which is sometimes accompanied by decreased joint mobility or deformity. In ankle joint replacement surgery, the worn down ends of the tibia and talus bones are removed and replaced with man-made components made of metal or plastic.

How does an ankle joint replacement work?

If you are considering ankle replacement surgery, it's likely that you have experienced chronic pain and reduced mobility due to arthritis. The procedure replaces the joint and the rough, worn bone ends with a polyethylene joint and smooth metal plates that move easily and without friction. Pain is massively reduced and, unlike other ankle procedures, there is no loss of mobility.

Consultation
During your initial consultation, your orthopaedic surgeon will discuss the ankle joint replacement procedure with you and tell you about any alternative treatments. He or she will explain what will happen on the day of the operation and tell you what you should expect afterwards. You will undergo a short examination, and the doctor will go over your medical history. An x-ray of your ankle will be taken, and your blood pressure will be checked. Your doctor will ask you about any current medications, including herbal remedies and vitamin supplements. You should inform your surgeon if have any underlying medical conditions or allergies. You should avoid smoking and alcohol in the weeks leading up to your operation. The surgeon will also answer any questions you may have about the procedure or preparation and aftercare.

Anaesthesia
Ankle joint replacement surgery can be performed under a general anaesthetic or a nerve block. At your initial consultation, the orthopaedic surgeon will help you to decide which is the best option based on your general health and your medical history.

Procedure
Ankle joint replacement is mainly performed using a technique called keyhole surgery. Your surgeon will follow these steps:

• A tourniquet will be applied above the ankle to stop blood flowing into the ankle. This allows the surgeon to see more clearly.
  
• An incision will be made on the front or side of the ankle. Sometimes, the primary incision is made on the front with two smaller incisions on either side of the ankle.
  
• Clamps will be placed at the edge of the main incision to open the area and allow access to the damaged joint.
  
• The ends of the talus and tibia will be cut to remove dead bone and create a smooth, even surface.
  
• Smooth metal covers will be placed over the exposed bone, and a strong plastic replacement joint will be inserted.
  
• Excess blood will be removed and the incisions will be stitched or stapled.
  
• A special dressing with a hard back and soft front will be applied and the foot will be elevated.
  

Are there different types of ankle joint replacements?

Although there is only one type of ankle joint replacement procedure, a similar alternative treatment is available:

• Ankle fusion: The damaged ankle joint is removed and the ends of the talus and tibia bones are fused together. Your ankle won't be quite as flexible as before, and you may lose some mobility. However, although running isn't recommended for some time after the procedure, you will be able to walk comfortably.

What should I expect?

Ankle joint replacement is a major medical procedure, and you should follow the orthopaedic surgeon's advice step-by-step. You should expect to feel some pain in your ankle immediately after the operation. There will be some swelling, and you will have to keep your foot raised for a couple of days. You will be unable to put any weight on your foot for several weeks. During this time, a cast or special cast boot is worn to protect the foot and ensure that the ankle joint replacement components heal in place. Although you will be immobilised for six weeks, once you begin to walk again, your ankle will be flexible and movement will be pain-free.