If you develop disabling pain in your ankle due to an arthritic condition, you may be a candidate for a Total Ankle Replacement (TAR). This procedure is one of the two definitive management options when non-operative measures fail to have the desired effect, the other being an ankle fusion (arthrodesis).
As opposed to an ankle fusion, which eliminates all motion in the ankle in order to eradicate the painful joint, an ankle replacement preserves or restores lost movement by simply resurfacing the affected joint surfaces, in a similar manner in principle to a total knee replacement. The degenerative or “worn out” joint surfaces are replaced by metal implants, and between these a polyethylene bearing is positioned. This allows for unimpeded and painless gliding motion. Joint deformity including malalignment is also addressed by the procedure. Other structures around the joint, including ligaments, tendons, nerves and blood vessels are preserved.
The precision of the ankle replacement is enhanced by the use of customised bone cutting guides. These are tailor made for each individual patient using data from a high-resolution CT scan of the extremity. Using this technology, nothing is left to chance in terms of implant position and alignment, and we know that this approach enhances the functionality and longevity of the operation.
Another great advantage of an ankle replacement over a fusion is that it allows for early weight-bearing on the extremity, just two weeks after the surgery! Patients use a CAM boot for four weeks and can completely wean walking aids whilst doing exercises to restore joint movement, from that time on.
Unfortunately, not everyone is an ideal candidate for a total ankle replacement and it is not a young person’s operation. As with any joint replacement, it wears out with time and can require a revision or redo replacement, although the longevity is unpredictable and most patients should expect 15 years or more. The operation is not recommended for diabetics with a peripheral neuropathy, those with severe vascular disease or anyone who has had significant deep infection about the ankle in the past.
Dr Newman can provide you with more information about the operation at the time of your appointment.