Total Ankle Replacement

When should it be considered?
When conservative measures of treatment fail to provide adequate pain relief, either an ankle fusion or ankle arthroplasty may be considered. Ankle fusion has been the traditional method of treating arthritis of the ankle, but in recent years the ankle replacement has developed as another choice. The ankle replacement hasn’t been around long, so long term follow-ups are few. However it does appear to have a shorter life span in younger people. For this reason ankle replacements are not usually recommended for people under the age of 50.

How to prepare for surgery

As you prepare for the surgery you should educate yourself about the procedure. Knowing what to expect can ease many fears and make recovery much smoother. If possible, find someone who has had the surgery to talk to.

If you are physically able, exercises to strengthen your upper body might be a good idea. Crutches will be used after the surgery and can be tough on weak arms.

Blood transfusions may be needed after TARs. Ask if you are a candidate for autologous blood donation, this means storing your own blood for transfusion. It is generally suggested you store 2-4 units of blood. The first donation must be given within 42 days of the surgery and the last, no less than seven days before your surgery.

Arrangements need to be made for your recovery. You will need assistance at home for several days to a couple of weeks after your discharge. If there is no one available to help you at home, a short stay in an extended care facility should be considered. Purchase or arrange rental of medical equipment you will need. Crutches and a wheelchair may be needed during your recuperation.

What happens during the surgery?

You will be given a general or spinal anesthetic. The doctor will make a cut over your ankle and expose the ankle joint. Then he or she will move the tendons aside and separate the leg bones (tibia and fibula) from the third ankle bone (talus). The doctor will remove the joint surfaces of the leg and ankle bone and secure the artificial replacement to the leg and ankle. Then the doctor will put the tendons back in place. She or he may place drains in the cut to drain any blood and then close the cut.

What happens after surgery?

You may be in the hospital for 1 to 4 days, depending on how quickly you heal. The ankle may be in a splint or cast to keep it stable. You may need blood transfusions. You may be given a blood thinner to avoid a blood clot to the lungs and to prevent swelling. A period of physical therapy is often required after ankle replacement. In a few weeks you should be able to walk on the new ankle.

Before discharge you will be given very specific instructions. The best surgeon in the world does not mean a successful recovery, YOU are responsible for your recovery. Follow all instructions and do your exercises faithfully.

Some of the normal home-going instructions include:

Wear elastic stockings (TEDS) if ordered until your follow-up appointment.Keep the incision clean and dry. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor.

What is the expected outcome of an ankle replacement?

You may regain use of the ankle and be able to walk without pain, help, or use of a cane or walker.

What complications may occur?

The most common complications are not directly related to the ankle and do not usually affect the result of the operation. These include blood clots in the leg, difficulty urinating and blood clots in the lung.

Swelling or pressure as a result of the procedure may injure the nerves in the ankle. The doctor may give you a blood thinner to try to avoid this problem. The new joint can be dislocated rather easily. There is a risk of infection and bleeding.

For more information:

Ankle
Joint.com
Personal
MD-Ankle Replacement

References:
Adult Health Advisor-

Ankle
Replacement, Copyright ? Clinical Reference Systems 1999

DePuy, Inc.