Your feet and ankles are extremely complex, including 26 bones, 33 joints, 107 ligaments, and 19 muscles. The ankle joint is where the leg and foot bones meet. The bones are coated with a smooth material called cartilage, and surrounded by strong ligaments. The cartilage minimizes friction as the bones glide on each other. The ligaments are bands of supportive tissue that provide stability and flexibility for range of motion, which is necessary for walking, running, and other activities.
The need for ankle replacement is usually severe arthritis or injury. When cartilage is damaged because of injury or arthritis, the result is pain and swelling in the ankle area. According to the American Academy of Orthopedic Surgeons, about 2 million Americans visit the doctor for ankle pain caused by arthritis or fractures every year. Thousands of people suffer from disabling ankle arthritis, where the cartilage is worn away almost completely. Ankle injuries are common in sports or exercise, because of the added stress on the joint. A history of ankle fractures, osteoarthritis, rheumatoid arthritis, and even obesity can increase your risk for ankle replacement.
Common symptoms of ankle arthritis or injury include pain, swelling, stiffness, and tenderness around the ankle. You may also notice weakness or instability when you try to put weight on the ankle or foot, making it difficult to stand or walk. In cases of arthritis, the symptoms usually get progressively worse over time. In cases of injury, the symptoms may appear immediately or within a few hours.
A physical examination of your ankle is the first step in diagnosis. The doctor will evaluate your range of motion and the amount of pain and swelling you are experiencing. Gentle pressure may be applied to pinpoint the source of your pain. An x-ray will be used to look for fractures, bone spurs, and damage to the cartilage. MRI or CAT scans are sometimes needed to gain more information on the condition of your ankle. Your primary doctor can do a basic evaluation, but a certified foot/ankle surgeon is the most qualified to diagnose these conditions.
If rest, heat/ice therapy, physical therapy, and anti-inflammatory medication do not improve your symptoms, consulting with an orthopedic surgeon who specializes in foot/ankle conditions is recommended. If the surgeon finds evidence of a poorly healed complex fracture or advanced (end-stage) arthritis, you may need ankle arthroscopy, ankle fusion, or a total ankle replacement.
Ankle arthroscopy can treat soft tissue injuries and minor arthritis, but severe ankle arthritis should be addressed by fusion or replacement. Ankle fusion will reduce the range of motion in your ankle, but for many cases of ankle arthritis, total ankle replacement is appropriate.
Ankle replacements have been around for decades, but early designs had limited success due to the complexity of the anatomy. Modern ankle replacements have made the surgery more successful. Orthopedic surgeons can match patients with an implant specifically designed to fit their ankle, which leads to better surgical outcomes and quality of life after ankle replacement surgery.
Total ankle replacement is also known as total ankle arthroplasty, or TAA. The procedure involves rebuilding the ankle joint with metal and plastic components. Additional surgery on tendons may also be done to improve the range of motion in your ankle. The surgery can sometimes be performed as an outpatient. Surgery is followed by post-operative rehabilitation.
You might be a candidate for ankle arthroplasty if you have osteoarthritis or rheumatoid arthritis that does not respond to conservative management; or if you need an ankle fusion but want to maintain full range of motion in your joint.
After surgery, you will work with a physical therapist to gradually strengthen and condition your ankle and return to your desired activity level. Most people make a full recovery within 6 to 12 months after surgery. Ankle replacement surgery enables you to achieve range of motion, increase function, and return to a more active lifestyle, with little or no pain. Thanks to improvements in modern ankle implants and techniques, ankle replacement surgery results have greatly improved.