All About Ankle Replacement Surgery

A fractured ankle or broken ankle means the either all or any one of the Tibia or Fibula or Talus bones, making up the ankle joint have broken. It may be a simple break in any of the bones (this may not immediately result in your immobility, though) to multiple fractures, dislocating the ankle, requiring you not to strain for some months.

Ankle fractures occur when the ankle joint or Syndesmosis joint (between fibula and tibia bones, being held together by ligaments).

Bunions and like foot and ankle deformities could be surgically removed by bunionectomy; surgical reconstruction (invasive methods of manipulating neuromusculoskeletal disorders) could be considered to treat the other deformities.

Normal symptoms of a fractured ankle include immediate and severe pain, bruising, swelling, tenderness while touching, inability to bear any weight and deformity. Surgical treatment is a necessity if your ankle remains unstable or if the fracture happens to be out of place.

Doctors will consider operation or ankle surgery only as a last resort, when their conservative non-surgical treatments (like high top tennis shoes, short leg cast, weight on the patient’s leg) do not respond to alleviating the symptoms.

Before deciding to conduct an ankle surgery, the doctors will carefully go through your medical history, analyze the existing symptoms and the method of injury having occurred and also thoroughly examine your foot, lower leg and ankle. In appropriate cases, he will call for one or more or all of the imaging tests.

These tests are a normal X-ray (indicating the displacements, number of breaks) of the relevant portion or Stress Test X-ray (a decisive test for necessity of surgery) or CT (Computed Tomography), showing the cross sections of the fractured parts or MRI (Magnetic Resonance Imaging) scan, showing in high resolution, the bones and ligaments and the like tissues. X-rays may have to be taken at different stages of the treatment to study the progress.

The treatment will include repositioning the bone fragments to their normal aligning positions using special metal plates or screws on the bone’s outer surface or a rod/ screw may inserted into the bone. The surgical treatment may differ based on whether it is lateral/ medial/ posterior malleolus or Bimalleolar/ Bimalleolar Equivalent Fractures or Trimalleolar Fractures or Syndesmotic Injury

Ankle surgery is exposed to additional risks like difficulty in the healing of the bones, arthritis and pain due to the plates/ screws, in addition to the general risks in any surgical treatment like pain, bleeding, infection, blood clots or damage to tendons, nerves or blood vessels. The patients and their families should be cautioned of these pre – till post-surgical possibilities, beforehand.

Why Ankle Replacement Surgery Is Done?

Ankle replacement surgery or arthroplasty helps in replacing damaged parts existing in any of your three bones that combines together to make ankle joints. Prosthetics or artificial joint parts which come in different sizes to fit different sized people are used by surgeons for replacing bones.

Ankle replacement surgery is carried out if your ankle joint has got severely damaged.  The various causes of ankle joint damage are as follows:

  • Infection
  • Bone fracture
  • Osteoarthritis
  • Arthritis due to any past ankle surgery
  • Rheumatoid arthritis

What To Do Before Surgery?

Before undergoing ankle replacement surgery, it is important that you tell your doctor in advance about drugs, herbs and supplements you have been taking with or without prescription for treating your ankle.

Before two weeks of surgery, take care of following things:

  • You should stop taking medicines like naproxen, aspirin and ibuprofen to avoid the chances of blood clotting during and after surgery.
  • Stop smoking as it slows down the process of wound and bone healing.
  • If you are diabetic or suffering from any heart ailment, it would be required for you to get these conditions checked by doctor before undergoing surgery.
  • Ask doctor about which drugs to be taken on the day of surgery.
  • If you take more than two glasses of alcohol in a day, make sure you disclose it your surgeon beforehand.
  • Tell your surgeon if you are suffering from cold, herpes breakout, flu or fever before your surgery.

What to do on the surgery day?

  • On the day of your ankle replacement surgery, you would be asked not to eat anything 6-12 hours prior to your surgery. Also doctor may suggest you to take some drugs with a sip of water.

Things To Be Done After Surgery And Risk Involved

After ankle replacement surgery, you may be required to stay in hospital for 4-5 days. Ankle will be bandaged. To reduce swelling, you may have to keep your foot raised higher than your heart while sleeping or resting.

Risk involved in ankle replacement surgery:

  • Damage to blood vessel
  • Weakness, instability and stiffness in ankle
  • Breakage of bone
  • Allergic reaction to artificial joint
  • Skin not healing after the surgery
  • Loosening of artificial joint over the period of time
  • Dislocation of artificial joint after some time
  • Nerve damage

Why Ankle Replacement Is More Preferable Than Bone Fusions?

When articular surfaces of the ankle joint get damaged, two options are open – one is arthrodesis meaning fusion of bones and the other is replacement of the damaged articular surfaces in the ankle joint with suitable prosthetic parts.

The later technology is termed as ankle arthroplasty or ankle replacement and is widely preferred by patients. Restoration of range of joint motions is the primary benefit in the ankle replacements when compared to arthrodesis, which was in vogue for a fairly longer time.

The resurgence of ankle replacements started in the genesis of this decade, thanks to the latest emerging technologies, which are being practiced with better success rates, when compared to the older ones. Ankle replacements pose fewer problems compared to ankle fusion.

For ankle joint replacements, the indications include extreme pain, associated with osteoarthritis or loss of mobility and functioning because of injury or post traumatic arthritis, rheumatoid arthritis and ankle osteoarthritis. The surgery is a major one and the success rates are convincingly well. Yet, the surgery may lead to complications which may arise from the surgery itself or post-operative care.

Some illustrative complications are dislocation of the joint, rejection of the graft, general and urinary tract infections, pneumonia and nerve damages, besides the normal risks, associated with surgeries any other kind like strokes, heart attacks, embolism, etc. The patients and their relatives are to be specifically warned of this. Rather the patient can withstand the pain and immovability.

You should avoid ankle replacement surgery if your physical condition is unhealthy like recovery from major illness/ surgery, worrying cardiac condition or any kind of infection. The joint can be ceramic or titanium or a compound. Other than the normal post-operative care, it would require some days of stay in the hospitals, some weeks of weights off those joints and fairly longer periods of training for strength and endurance.

Cost-wise, it may not be that much costly, when compared to other kinds of surgeries; but still costlier, if you do not have sufficient coverage. If you have insurance, you can claim the eligible amounts from the insurer.

At present, there are methodologies for two components implants. Mobile bearing three components (third component made of medical grade polyethylene) ankle replacement systems are under study and also in clinical trials. The total ankle replacements system by Bone Innovations (S.T.A.R.) had the approval of the FDA in the month of May, 2009.