Until recent years, the option of Total Ankle Replacement, has been limited by relatively unpredictable or poor outcomes, especially when compared to the hip or knee. Advances in the design of the prostheses and techniques of implantation have improved significantly, and there is growing body of medium to long term evidence supporting the procedure for particular patients.
Ankle replacement aims to relieve the pain of arthritis, whilst preserving any remaining movement, and allowing patients to return to a lifestyle including things like walking, gardening, golf or other non-impact activities. Recovery is generally easier than for an ankle fusion.
The time to consider undergoing ankle replacement surgery is when the pain in your joint is so severe that it is having a significant impact on your day to day activities. It is important that you have tried all reasonable non-surgical treatments, as some patients with severe arthritis on their x-rays can still cope quite well without surgery. It is not until your pain is fairly constant and severe that the potential benefits of surgery outweigh the risks and make it worthwhile going through the recovery period.
Other treatment options such as ankle arthroscopy, ankle fusion, or excision of spurs around the joint may be more appropriate in your particular case.
In general, the patients for whom ankle replacement is most appropriate are
- Elderly (<65 years).
- Not involved in regular high levels of activity, sport, or manual labour.
- And still have a reasonable range of movement in their arthritic ankle joint.
Patients with diabetes, rheumatoid arthritis, or who smoke, are at a much higher risk of complications from surgery and may choose to avoid an operation at all.
You will be given a full briefing of how to prepare for your Ankle Replacement well in advance of the day of surgery. In very general terms you will need to...
- Let our team know what other medication you are taking and follow our guidelines on taking these medications in the days/weeks before surgery.
- This is particularly pertinent to blood thinning medications such as aspirin, warfarin, clopidogrel and Xarelto.
- Let our team know if you develop symptoms of any illness (including a cold or fever) or if you believe you may be pregnant.
- If you smoke, stop smoking ideally several days or weeks ahead of the procedure, but at the very least not smoke after midnight the night before surgery.
- Maintain your strength and mobility as best as possible, some patients attend physiotherapy prior to the surgery in preparation.
- Not eat or drink anything for a minimum of 8 hours prior to admission.
- Bring all available and relevant imaging with you to hospital.
The prostheses and procedure used by Mr Callahan are known as “In Bone” or “Infinity” prostheses typically inserted using a “Prophecy” technique.
For the “Prophecy” technique, you will have a CT scan of the ankle done at least 8 weeks prior to the surgery. These images are used to create a virtual model of the ankle as it is, and plan exactly where to place the prosthesis. Cutting guides that perfectly match the shape of your bones are then 3D printed to allow the exact reproduction of the planned positioning during the actual surgery. These are sent to the hospital ready for your surgery.
You will be admitted to the hospital on the day of surgery. General anaesthesia may be supplemented with a nerve block.
An incision on the front of the ankle allows access to position the patient specific cutting guides, the joint is excised, and metal components are placed into the joint. A polyethylene plastic spacer is added, and the joint is checked for alignment, stability and range of movement. If tendon lengthening or extra stabilization procedures are required, they are done at this stage.
The incision is sewn closed and the foot is placed in a cast or cam walker boot.
Immediately after surgery, the foot must be kept elevated (above the level of the heart) to reduce swelling. This is especially important over the first 2 weeks. Patients also receive pain medication at this time.
The day after surgery you will be instructed by the physiotherapists on mobilization. You must not walk on the foot for the first 2 weeks. Most patients will stay in hospital for 3-4 days. Once you are able to get around independently you will be able to go home.
You will be seen for a wound check at 10-14 days and should be allowed to start walking in the boot thereafter. It is important to see a physiotherapist over this time to help with movement and swelling control. After 6 weeks, an x-ray will be checked and you should be able to keep the cam walker boot off and return to normal activities.
For more information, please refer to:
All surgery carries with it some form of risk. Common risks that apply to all surgery, including an ankle replacement, are...
- Formation of a blood clot (“DVT” or deep vein thrombosis) Pieces of clot in the leg can break off and lodge in the lungs causing a pulmonary embolism. This can be very serious, and in rare cases even cause death.
- Nerve damage
- Difficulty getting the wound to heal
- Abnormal pain reactions or nerve hypersensitisation known as complex regional pain syndrome (CRPS)
Risks specifically related to this procedure include...
- Fractures occurring during surgery.
- Incomplete relief of pain.
- Failure of the prosthesis to bond onto the bone.
- Stiffness or reduction in the range of movement of the joint.
- Instability of the joint or developing deformity.
- Long term wearing out or loosening of the prosthesis.
- Arthritis developing in other joints of the foot.
Download Inbone Total Ankle System (PDF – 2500 Kb)