Candidates for ankle joint typically suffer from arthritis that has led to the degeneration of the ankle joint(s), reducing patients’ quality of life, even after extensive nonsurgical treatment. Patients who do not want ankle fusion, which limits the range of motion of the ankle, may also be good candidates for ankle joint replacement. Typically, those who have rheumatoid arthritis are good candidates as well.
Patients who suffer from an active ankle infection, or those who have a significant deformity or necrosis (dead bone) in the talus (one of the bones in the ankle joint) are not suitable candidates for ankle joint replacement. Other conditions that may complicate an ankle joint replacement include inadequate leg muscle function, poor blood flow of the leg, or inadequate soft tissues around the ankle.
Like other surgeries, ankle joint replacement requires a complete physical examination with some kind of imaging (X-ray, MRI) of your affected ankle by your primary care provider and/or orthopedic surgeon before surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with certain general surgery protocol such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Your home should be modified to be more comfortable and ensure a safe and rapid recovery. It is a good idea to move your bed to the first floor and to get rid of hazards such as loose rugs.
Immediately after your procedure, you should keep the affected ankle elevated to minimize swelling. An overnight hospital stay of one night or more may be required. Your doctor will prescribe medication for pain relief, or maybe install a “pain pump,” which automatically dispenses medication for 1-3 days after the procedure. An extended period of not wearing weight on the affected ankle is required for proper healing. During this time, patients should use crutches, walkers, or other ways to get about without placing weight on the healing ankle. Swelling and pain are expected in the first few weeks postoperative, but can be managed with pain medication and continuing to keep the ankle elevated above the heart.
Any stitches or staples will be removed 2 weeks after surgery. You can expect to wear a cast or boot for an extended amount of time. A formal physical therapy program (beginning a week after surgery) will also help you as you learn exercises to maintain a pain-free range of motion. Patients are generally able to stop using a boot or any kind of aid 12 weeks after surgery, with a gradual return to more vigorous activity.
As with any surgery, there are risks of complications related to infection, damage to nerves and blood vessels, bleeding and blood clots, or adverse reactions to anesthesia. Risks specific to ankle joint replacement include ankle weakness, stiffness or instability, loosening of the joint in the long term, dislocation of the artificial joint, or allergic reaction to the artificial joint.