Treating Ankle Arthritis with Total Ankle Replacement

Also called total ankle replacement, a surgical procedure called total ankle arthroplasty (TAA) is used to treat ankle arthritis. Without treatment, this form of arthritis can lead to loss of cartilage, pain and possibly deformity.

The goal of TAA is to improve ankle motion and create less pain during regular activities. Here are some basic facts about ankle arthritis, signs TAA might be needed and details of the procedure.

 

Ankle Arthritis Basics

 

In healthy ankles, bones are covered by cartilage, a smooth protective substance. Cartilage allows the ankle joint to move properly, but if it becomes thinner and rougher than normal, arthritis can develop.

Arthritis is more common in joints that have been injured or have undergone “wear and “tear.” This affects the knee and hip most commonly, but can also affect the ankle. Risk factors for developing ankle arthritis include:

• Obesity
• Family history
• Increasing age
• History of injuries like fractures or numerous sprains
• Rheumatoid disease
• Ankle infection

 

Signs TAA is Needed

 

If less invasive methods of limiting pain are unsuccessful, TAA might be considered. More conservative methods include medications (for pain and inflammation), bracing, physical therapy and activity modifications. In many cases, rheumatoid arthritis patients are good candidates for TAA.

Alternatively, TAA is not suited for patients with significant deformity or dead bone in the talus or the bottom bone of the ankle joint. It also shouldn’t be performed on people with prior or current ankle infections, lower extremity neuropathy, inadequate or absent leg function, poor blood flow to the leg or inadequate soft tissues.

 

During The Procedure

 

A few general details to be aware of during the TAA procedure include:

• TAA is performed either under general anesthetic or a nerve block.
• A tourniquet will be used to control bleeding and improve visualization.
• The ankle is approached from the front or side, depending on the type of implant being used.
• Bone is cut, and components meant to recreate the ankle joint are placed in.
• If a tight calf or Achilles muscle needs to be lengthened, this will be done during the procedure.
• Wounds are closed using stitches or staples, and a splint is applied.

 

After The Procedure

 

You’ll likely spend one or more nights in the hospital after the procedure, and there will be a period of immobilization and non weight-bearing activity during recovery. Elevation will be required for several days to control swelling and increase healing. Once wounds have healed, your surgeon may allow you to work on non weight-bearing range-of-motion activities. Weight-bearing activity can usually begin a few weeks after surgery if X-rays indicate positive healing.

 

Possible Complications

 

There are a few complications and risks to be aware of and potentially discuss with your surgeon before a TAA:

• Anesthesia risks
• Infection
• Damage to nerves or blood vessels
• Fracture of bone on either side of the implant (the most common complication)
• Injury to tendons
• Wound healing issues in people who smoke, who have diabetes or who have rheumatoid arthritis
• Failure of ankle implant to heal into the bone

 

If you’re dealing with painful ankle arthritis, speak to your doctor to see if total ankle replacement is right for you.

 

Our orthopedics practice has provided care for over 30 years. Our staff is trained handle a variety of issues, including sports medicine. We care for you and your family with the same state-of-the art techniques we use with BYU and Olympic athletes.

 

Sources:

 

“Total Ankle Arthroplasty.” American Orthopedic Foot & Ankle Society. http://www.aofas.org/footcaremd/treatments/Pages/Total-Ankle-Arthroplasty.aspx

“Ankle Arthritis and Total Ankle Replacement.” Cleveland Clinic. https://my.clevelandclinic.org/health/articles/ankle-arthritis-and-total-ankle-replacement