Total Ankle Replacement

Total ankle replacement, also known as total ankle arthroplasty, is a surgical procedure where the damaged or arthritic ankle joint is replaced with an artificial joint. The goal of the surgery is to alleviate pain, restore mobility, and improve the overall quality of life for patients with severe ankle arthritis.

Indications

Total ankle replacement is typically recommended for patients who have:

• Severe ankle arthritis, including osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis
• Failed conservative treatments, such as physical therapy, bracing, and pain management
• Significant pain and limited mobility that interferes with daily activities
• Adequate bone quality and no significant deformity or instability

Surgical Procedure

The total ankle replacement surgery involves the following steps:

1. The patient is given general anesthesia or regional anesthesia to numb the area.
2. An incision is made in the front of the ankle, and the surgeon dissects the tissue to expose the joint.
3. The damaged cartilage and bone are removed from the tibia (shinbone) and talus (ankle bone).
4. The artificial joint components, including a metal tibial component and a plastic or ceramic talus component, are implanted.
5. The surgeon may also use bone cement to secure the components in place.
6. The incision is closed, and the ankle is immobilized in a splint or cast.

Types of Total Ankle Replacement Implants

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

• Salto Talaris: A mobile-bearing implant that allows for natural movement and rotation.
• Scandinavian Total Ankle Replacement (STAR): A fixed-bearing implant with a metal tibial component and a polyethylene talus component.
• Agility Total Ankle System: A semi-constrained implant that allows for some movement and flexibility.

Risks and Complications

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

• Infection
• Blood clots or deep vein thrombosis
• Nerve damage or numbness
• Bone fracture or loosening of the implant
• Wound healing problems

Recovery and Rehabilitation

After total ankle replacement surgery, patients typically require:

• 6-12 weeks of non-weight-bearing immobilization in a cast or splint
• Physical therapy to regain strength, range of motion, and mobility
• Pain management with medication and other interventions as needed
• Follow-up appointments with the surgeon to monitor progress and remove sutures or staples

Outcomes and Expectations

Total ankle replacement can provide significant pain relief, improved mobility, and enhanced quality of life for patients with severe ankle arthritis. However, outcomes may vary depending on individual factors, such as:

• Severity of pre-operative symptoms and deformity
• Presence of comorbidities or underlying medical conditions
• Adherence to post-operative rehabilitation protocols

Long-Term Results

Studies have shown that total ankle replacement can provide durable and long-lasting results, with:

• 90-95% of patients experiencing significant pain relief at 5-10 years post-operatively
• 80-90% of patients maintaining improved mobility and function at 5-10 years post-operatively
• A revision rate of approximately 10-20% at 10-15 years post-operatively