Ankle Replacement Surgery - Indications, Contraindications, Procedure, and Risks

Introduction:

Ankle replacement, also known as ankle arthroplasty, is a surgical procedure to replace a damaged ankle with prostheses. The prosthetic joint functions almost as close to the natural joint as possible.

Why Is Ankle Replacement Surgery Done?

The principal cause behind an ankle replacement is in individuals whose joint pain cannot be managed by any other means, such as physical therapies and medication, which affects the overall quality of life. This pain may result from ankle arthritis, repetitive strain injuries to the joint, and fractures caused by traumatic situations. Ankle arthritis causes severe pain, inflammation, and stiffness, making walking difficult. Different types of ankle arthritis include:

• Osteoarthritis: This condition is mainly observed in older people.

• Rheumatoid Arthritis: It is an autoimmune disease affecting joints.

• Post-traumatic Arthritis: It occurs because of an injury that happened in the past.

Mild to moderate arthritis is treated by other means, such as pain medicines, special shoes, physical therapy, etc. If severe symptoms remain and affect daily activities, ankle replacement surgery may be advised.

What Are the Symptoms That Necessitate Ankle Replacement Surgery?

The symptoms of ankle replacement include mostly those associated with ankle arthritis. These symptoms are listed as follows;

• Pain in the ankle joint cannot be managed by medication or therapy.

• Difficulty standing and walking.

• Swelling of the joints.

When Should Ankle Replacement Surgeries Be Avoided?

Case selection is vital for any elective surgical procedure. The consulting specialist must assess the risk-benefit ratio before opting for ankle replacement. The conditions where the surgical option is avoided are as follows;

• Infections of the ankle joint.

• Systemic diseases such as diabetes mellitus.

• Obesity.

• Circulatory diseases.

• Patients with cardiac problems.

What Are the Potential Post-operative Risks Following Surgery?

Though ankle replacement surgeries have a high success rate, certain risks must be considered, as with any other surgical procedure. The post-operative risks following ankle replacement are as follows;

• Infection of the surgical site.

• Damage to nerves and blood vessels around the surgical site.

• Bleeding of the wound.

• Blood clots may disseminate to other vital organs, such as the lungs.

• Malunion or nonunion of the bones due to inappropriate technique or underlying disease.

• Improper alignment of the bones leads to further pain.

• Development of arthritis de novo in neighboring joints.

• Loosening of the prosthesis may require repeat surgeries.

• Wearing out of the prosthetic components with time, depending on the quality of the material used.

The complications vary according to the patient's age and underlying medical conditions. For instance, a smoker or an individual with low bone mineral density may be at an elevated risk of certain complications.

How Is a Patient Prepared Preoperatively?

• The patient is asked to stop taking medication such as blood thinners at least two to three weeks before surgery.

• The patient should quit smoking in advance before the procedure can be conducted.

• Some changes in living arrangements are needed, such as learning to use crutches and having assistance in being driven.

• Avoid food and drinks the night before the procedure.

What Are the Imaging Techniques Used to Diagnose the Need for Ankle Replacement?

Imaging tests that are needed before the surgery are:

• X-rays.

• Computed tomography (CT) scans.

• Magnetic resonance imaging (MRI) scans.

What Is the Procedure for Ankle Replacement Surgeries?

An orthopedic surgeon performs the surgery. The procedure usually takes a few hours. The steps involved are as follows;

• The patient is put under general anesthesia.

• A relevant specialist continually monitors vital signs such as heart rate and blood pressure during the operation.

• The surgical site is disinfected before an incision through the skin and muscle of the ankle can be made.

• The damaged tissues of the shin bone and talus are then surgically removed and reshaped to house the prosthesis that is to be attached.

• New metal joint surfaces are added to the now reshaped pieces of the remaining bones, with or without cement, to hold the prostheses in place.

• Plastic may be inserted between the prosthetic joint spaces to allow easy gliding movements over one another.

• The layers of skin and muscle around the ankle and the foot are then closed and sutured, and a surgical dressing is placed.

How Does Post-operative Recovery Occur After Surgery?

The specialist will brief the patient after the surgery on the possible outcomes. The medical team monitors the recovery continually. The affected leg is immobilized and elevated after the surgery to ensure that the bones are aligned and can heal in the appropriate place with time. A regular diet will be resumed as soon as the patient can. The consulting surgeon may order follow-up X-rays to evaluate the surgical efficacy. Depending on the underlying conditions, a few days of in-hospital stay may also be recommended. The patient might complain of significant post-operative pain that needs to be addressed using pain medication. The patient may need to wear a surgical splint for a couple of weeks, depending upon the quality of the bone and the duration of healing, along with the use of prosthetic devices such as crutches, canes, or walkers for several weeks to a month with specific instructions regarding foot movement while in post-operative recovery. Rest and elevation of the leg are necessary, at least for a week or two post-operatively, and full body weight should not be put on the affected foot for at least a few months.

The surgeon’s office should be notified immediately if the following occurs;

• Increased pain at the surgical site or incision

• High fever or chills.

After a few weeks after the surgery, the splint may be removed and replaced with a removable boot or a cast. Physical therapy is recommended for a few months to enhance the strength and range of motion of the affected foot. It may take several months before the patient can return to preoperative activities. Post-operative instructions should be followed carefully.

Conclusion

Ankle arthroplasty is a surgical procedure that uses prostheses to eliminate a damaged ankle. Pain in the ankle joint may result from ankle arthritis, repetitive strain injuries to the joint, and fractures caused by traumatic situations.