What is ankle replacement surgery?

Ankle replacement surgery is the replacement of the damaged cartilage and bone in the ankle joint with an artificial implant.

The ankle joint (tibiotalar joint) is where your shin bone (tibia) rests on top of a bone of your foot (talus).

Arthritis can affect this joint as well as other joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This can result in pain, inflammation, and swelling of your joint.

Ankle replacement surgery is a procedure to replace this damaged joint to eliminate this pain and swelling and to restore its function.

Why might I need ankle replacement surgery?

Ankle replacement surgery may make sense for you if you have severe arthritis in your ankle. This can cause symptoms, like severe pain, inflammation, and stiffness, which can lead to difficulty walking. The main types of ankle arthritis are:

• Osteoarthritis. This is wear and tear arthritis that develops in older adults.

• Rheumatoid arthritis. This is a systemwide autoimmune disease that affects the joints.

• Posttraumatic arthritis. This can happen because of a past injury of your joint.

If you have mild or moderate arthritis, your healthcare provider will probably recommend other treatments, like pain medicines, special shoe and foot inserts, physical therapy, or corticosteroid injections. If you still have severe symptoms that get in the way of your daily activities, your healthcare provider may recommend ankle replacement or another surgical procedure.

If your arthritis isn't yet severe, arthroscopic debridement might be a better choice. Ankle fusion is another choice for people with severe arthritis of their ankle. Each of these choices has its own risks and benefits. Talk with your healthcare provider about all your treatment and surgical choices.

Ankle Arthritis | Q&A with John Thompson, M.D.

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What are the risks of ankle replacement surgery?

Ankle replacement surgery is very successful in most cases, but it does have some risks. These include:

• Infection

• Damage to nearby nerves

• Bleeding

• Blood clot

• The bones not joining together properly

• Misalignment of the bones

• New arthritis in neighboring joints

• Loosening of the artificial components, which might eventually need a follow-up surgery

• Wearing out of the components

Your own risk of complications may vary according to your age and your other medical conditions. For example, if you smoke or have low bone density, you may have an increased risk of certain complications. People with diabetes may also have an increased risk. Talk with your healthcare provider about all your concerns, including the risks most relevant to you.

How do I get ready for ankle replacement surgery?

Talk with your healthcare provider about what to do to prepare for your ankle replacement surgery. Ask whether you should stop taking any medicines, like blood thinners, ahead of time. If you smoke, try to stop smoking before your procedure. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines like aspirin. Also, tell your healthcare provider about any changes in your overall health, such as a recent fever.

Before your procedure, you may need additional imaging tests, like X-rays, a CT scan, or an MRI.

You may need to change your living arrangements as you recover because you’ll need to use crutches for several weeks. Have someone available to drive you home from the hospital.

You’ll need to avoid food and drink after midnight the night before your procedure.

What happens during ankle replacement surgery?

Your healthcare provider can help explain the details of your particular surgery. An orthopedic surgeon will perform your ankle replacement, helped by a team of specialized healthcare providers. The whole operation may take a few hours. In general, you can expect the following:

• You may be under general anesthesia. This is medicine that puts you to sleep and keeps you from feeling pain during the surgery. Or you may have regional anesthesia. This numbs the surgical area so you don’t feel pain. With regional anesthesia, you can breathe on your own.

• A healthcare professional will carefully monitor your vital signs, like your heart rate and blood pressure, during the operation.

• After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your ankle, and possibly another one on your foot.

• Your surgeon will remove the damaged portions of your tibia and talus.

• Next, your surgeon will attach the new metal joint surfaces into the pieces of your remaining bones. Your surgeon might use a special type of cement to hold them in place.

• Your surgeon will also probably insert a piece of plastic between the new metal joint spaces so they can glide easily against each other.

• Your surgeon may make other necessary repairs.

• Your surgeon will surgically close the layers of skin and muscle around your ankle and foot.

What happens after ankle replacement surgery?

Talk with your healthcare provider about what you can expect after your surgery. Your medical team will continue to monitor you carefully as you recover. When you wake up, your leg will probably be immobilized and elevated. You can resume a normal diet as soon as you're able. You may need follow-up X-rays to see how your surgery went. You may be able to go home the same day, or you may need to stay in the hospital for a few days.

You may have significant pain right after your surgery, but pain medicines may help ease the pain. The pain should begin to diminish over a few days, and you should have less pain than before your surgery.

After your surgery, you'll probably need to wear a splint for a couple of weeks. You might also need to use crutches for several weeks. Your healthcare provider will give you instructions about how to move your foot while you recover. It may be helpful to rest and elevate your leg for the first week or so after your surgery. You won’t be able to put your full weight on your foot for a few months.

You won’t be able to see your incision initially, but let your healthcare provider know right away if the pain increases or if you have a high fever or chills.

Make sure to keep all your follow-up appointments so that your healthcare provider can monitor your progress. You may have your splint removed and replaced with a boot or a cast a couple of weeks after your surgery. This boot or cast may come off several weeks later. You might need physical therapy for a few months to help you maintain your strength and range of motion. It may be several months before you can return to all your previous activities.

Carefully following your healthcare provider’s instructions about rehabilitation, medicines, and wound care should increase your chances of a good outcome.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure