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Total Ankle Replacement

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Total ankle replacement is an orthopedic surgical procedure done to individuals with debilitating ankle diseases to alleviate pain and restore their mobility.

Written by

Dr. Varshini

Medically reviewed by

Dr. Anuj Gupta

Published At August 28, 2023
Reviewed AtMarch 22, 2024

Introduction:

The domain of orthopedic surgery has witnessed a veritable sea change with the advent of total ankle replacement (TAR). This groundbreaking procedure has emerged as an elixir for individuals grappling with debilitating ankle pain, paving the way for renewed mobility, enhanced quality of life, and a resplendent future.

What Is Total Ankle Replacement?

Total ankle replacement (ankle arthroplasty) is a surgical procedure meticulously crafted to replace the damaged joint surfaces of the ankle with an artificial joint, fostering a harmonious blend of motion, stability, and durability. Unlike traditional remedies such as ankle fusion, which restrict motion in the joint, total ankle replacement preserves the inherent motion, thereby enabling patients to engage in a broader range of activities.

Who Is Indicated for Total Ankle Replacement?

  • Total ankle replacement is recommended for individuals with end-stage arthritis in cases of osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. In such individuals, there is a history of chronic pain sensation, joint stiffness, and limited mobility.

  • When non-surgical treatments such as medications, physical therapy, bracing, corticosteroid injections, or ankle arthrodesis (fusion) have failed to provide adequate relief or functional improvement, total ankle replacement may be considered.

  • The crux of total ankle replacement's indications lies in its potential to restore functionality and alleviate the disability imposed by a deteriorating ankle joint. Individuals experiencing significant functional limitations due to ankle pain, stiffness, and instability find solace in the prospect of total ankle replacement.

  • In cases of previous history of repeated ligament injuries and completely damaged joints, total ankle replacement can be a great option.

  • Patients who desire to maintain or restore ankle motion and functionality rather than opting for ankle fusion, which permanently limits joint movement, may be good candidates.

  • Sufficient bone quality and quantity are important for the successful placement and fixation of the implant components.

What Are the Contraindications for Total Ankle Replacement?

  • The insufficient bone quality or quantity can hinder the successful placement and fixation of the implant components. Conditions such as severe osteoporosis or bone loss due to previous surgeries or infections may compromise stability and longevity.

  • The presence of an active infection in or around the ankle joint is an absolute contraindication.

  • Infection can interfere with the healing process, increase the risk of implant-related complications, and compromise the success of the procedure.

  • Total ankle replacement requires adequate soft tissue coverage around the ankle joint for proper wound healing and prevention of infection. Patients with compromised soft tissue and neurological damage are not indicated for the procedure. Conditions like severe peripheral arterial disease or complex regional pain syndrome may also increase the risk of complications.

  • Systemic diseases that cause immunodeficiency, like chronic diabetes mellitus, chemotherapy, hypertension, or autoimmune disorders, can affect the prognosis and increase the risks of the procedure. Hence, such individuals are not indicated.

How Is Total Ankle Replacement Done?

  • Before the surgical procedure, a complete physical examination, medical history, and personal history will be obtained. This is followed by investigative procedures like hematological tests (bleeding time, clotting time) and radiographic tests like X-ray and CT to assess the position for ankle implant placement. This assessment also helps the surgeon determine the extent of joint damage, evaluate the patient's overall health, and identify any potential risks or contraindications.

  • General anesthesia or a regional block to the ankle will be given to numb the region.

  • The damaged joint surfaces, including the ends of the tibia (shinbone) and talus (ankle bone), are carefully removed using specialized surgical instruments. The joint is prepared for the implant components.

  • The prosthetic components are placed into the prepared joint space. This involves placing the metal components (femoral and tibial components) onto the corresponding bone ends. The components may be fixed to the bone using bone cement or fit techniques. A polyethylene insert, which acts as a cushioning layer, is positioned between the metal components. The insert allows for smooth articulation and reduces friction within the joint. It absorbs shock and provides stability during movement.

  • The new joints are then checked for their range of motion and stability. Radiographic examinations of the placed implants are done to ensure that they are placed in the correct position.

What Are the Prosthetic Materials Commonly Used in Ankle Replacement Surgery?

The prosthetic components utilized in total ankle replacement are a testament to the marvels of modern engineering prowess. Constructed from cutting-edge materials such as cobalt chromium, titanium alloys, and high-density polyethylene, these implants flawlessly mimic the intricate anatomy of the ankle joint. The state-of-the-art design ensures optimal load transmission, minimizing stress on neighboring joints, and optimizing longevity, promising years of seamless functionality.

What Are the Post Operative Instructions to Be Followed?

  • Prioritize ample rest and limit weight-bearing activities.

  • Take prescribed pain medications as directed and communicate any concerns or changes in pain levels to your surgeon.

  • Physiotherapy modalities like transcutaneous electrical nerve stimulation (TENS) or interferential therapy (IFT) are recommended for alleviating pain in the ankle region.

  • Adhere to any lifestyle modifications recommended by the surgeon, such as avoiding certain activities or wearing supportive footwear, to protect and maintain the longevity of the total ankle replacement.

  • Gradually reintroduce activities and listen to the body's signals to prevent overexertion or complications.

What Are the Benefits of Total Ankle Replacement?

By replacing the ailing joint, total ankle replacement rekindles mobility, allowing individuals to stride, sprint, and revel in newfound freedom. The preservation of natural joint dynamics bestows a sense of normalcy, facilitating a wide spectrum of activities. It also liberates individuals from chronic agony, empowering them to embrace an active existence. Unlike ankle fusion, which locks the joint in a fixed position, total ankle replacement permits a natural range of motion, facilitating activities that necessitate plantar flexion, dorsiflexion, and lateral movement.

What Are the Complications of Total Ankle Replacement?

  • There is a possibility of infection in the surgical site, causing delayed wound healing.

  • Temporary or permanent loss of sensation.

  • Clotting of blood, further exacerbating conditions like thrombosis.

  • Allergy to implant material.

  • Wear and tear of the implant causing failure.

  • Excessive bleeding resulting in blood loss.

Conclusion:

In conclusion, total ankle replacement stands as a beacon of hope for those grappling with incapacitating ankle pain. Through the fusion of modern materials and surgical precision, this innovative procedure unlocks a world of possibilities where individuals can revel in the joy of movement and bid adieu to chronic pain. Breakthroughs in research in the future can pave the way for a better and customized ankle replacement procedure.

Dr. Anuj Gupta
Dr. Anuj Gupta

Spine Surgery

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