Total Ankle Arthroplasty

Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure used to treat severe ankle arthritis and other conditions that cause pain and stiffness in the ankle joint.

Indications

• Ankle osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Avascular necrosis of the talus
• Failed previous ankle surgeries

Procedure

The procedure involves replacing the damaged or arthritic ankle joint with an artificial one, composed of metal and plastic components. The surgery is typically performed under general anesthesia or regional anesthesia.

1. The surgeon makes an incision in the front of the ankle to access the joint.
2. The damaged cartilage and bone are removed from the tibia (shinbone) and talus (ankle bone).
3. The metal components are attached to the tibia and talus using a special cement or press-fit technique.
4. A plastic spacer is inserted between the metal components to allow for smooth movement of the joint.
5. The incision is closed, and the ankle is immobilized in a cast or splint.

Types of Implants

There are several types of total ankle arthroplasty implants available, including:

• Salto Talaris Total Ankle Prosthesis
• Scandinavian Total Ankle Replacement (STAR)
• Agility Total Ankle System
• Zimmer Trabecular Metal Total Ankle

Recovery and Rehabilitation

After surgery, patients typically spend several days in the hospital for pain management and monitoring. A rehabilitation program is essential to regain strength, range of motion, and function in the ankle.

1. Pain management with medication and physical therapy
2. Immobilization in a cast or splint for 2-6 weeks
3. Gradual weight-bearing and mobilization
4. Physical therapy to improve range of motion, strength, and balance

Risks and Complications

As with any surgical procedure, total ankle arthroplasty carries risks and potential complications, including:

• Infection
• Blood clots
• Nerve damage
• Implant failure or loosening
• Wound healing problems

Outcomes and Expectations

Total ankle arthroplasty can provide significant pain relief, improved function, and enhanced quality of life for patients with severe ankle arthritis. However, the outcome depends on various factors, including the patient's overall health, implant type, and rehabilitation program.

Patient satisfaction rates vary, but most studies report:

• 80-90% of patients experience significant pain relief
• 70-80% of patients show improved function and mobility
• 10-20% of patients may require revision surgery due to complications or implant failure