Ankle replacement is surgery to replace the damaged parts of the three bones that make up the ankle joint. Artificial joint parts (prosthetics) are implanted in place of the old bones. The artificial ankle joints come in different sizes to fit the patient.

This procedure may be done with general anesthesia (unconscious, no pain) or a spinal anesthetic (awake, but no feeling below the waist). If you are receiving spinal anesthesia, you will also receive medicine to help you relax during the operation.

The surgeon makes a cut in the front of the ankle to expose the ankle joint. After gently pushing the tendons to the side, the surgeon disconnects the shin bone (tibia) and the smaller lower leg bone (fibula) from the main bone of the ankle (talus). The damaged surfaces of the bones are removed, and the artificial joint is attached. Screws are also commonly used to help support the artificial ankle.

After putting the tendons back into place, the surgeon closes the wound with stitches. A brace may be used to keep the ankle from moving.

Ankle replacement surgery may be performed if the ankle joint has been severely damaged. Causes of damage include:

• Osteoarthritis
• Rheumatoid arthritis  
• Fracture
• Arthritis due to previous ankle surgery

Risk for any type of surgery includes:

• Bleeding
• Blood clot
• Infection

Additional risks for ankle replacement surgery include:

• Loosening of the artificial joint over time
• Nerve damage
• Blood vessel damage
• Bone break during surgery
• Ankle weakness, stiffness, instability
• Dislocation of the artificial joint
• Allergic reaction to the implant

After surgery, you will need to stay in the hospital for up to 4 days. Your doctor may recommend physical therapy to improve ankle motion. To avoid swelling, the foot may be raised higher than the heart while sleeping or resting.

Recovery can take 2 - 3 months. You should stay off your foot for several weeks, and use a walker or crutches. High-impact activities, such as step aerobics, should be avoided while recovering from ankle replacement surgery.

A successful ankle replacement will eliminate pain and allow the ankle to move up and down. In general, total ankle replacements last from 10 to 15 years, depending on the patient’s activity level and overall health.

Discuss the risks and benefits of this procedure with your health care provider.

Su EP, Kahn B, Figgie MP. Total ankle replacement in patients with rheumatoid arthritis. Clin Orthop Relat Res. 2004 Jul;(424):32-8.

Knect SI, Estin M, Callaghan JJ, et al. The Agility total ankle arthroplasty. Seven to sixteen-year follow-up. J Bone Joint Surg Am. 2004 Jun;86-A(6):1161-71.

Hebert MB, Coetzee JC. The Agility Total Ankle Replacement: A Prospective Outcome Study with Minimum Two Year Follow-Up. Washington, DC. American Academy of Orthopaedic Surgeons' 2005 Annual Meeting. Podium Presentation. February 24, 2005. Paper No: 126.