Ankle Replacement Surgery
Who is Suitable for Ankle Replacement Surgery?
Ankle replacement surgery is most commonly carried out on people suffering with severe arthritic symptoms in the ankle. Arthritis causes stiffness and pain in the ankle, along with difficulty walking. Although ankle arthritis can sometimes be treated with non-surgical treatments such as medications and lifestyle changes, if symptoms are impacting on your day-to-day activities, ankle replacement surgery is probably worth considering.
Symptoms of Ankle Arthritis
The ankle joint itself is less affected by arthritis compared to other joints; however, when ankle arthritis does occur, it is usually because the tibiotalar joint has worn out (the joint between the tibia (shin bone) and the talus (ankle bone)). Typical symptoms of ankle arthritis include:
- Joint stiffness and tenderness when touched
- Swelling around the ankle joint
- Pain when moving or weight bearing
- Deformity of the joint
- Instability, or a feeling that the ankle will ‘give out’
- Pain and swelling after rest, such as sitting for long periods or sleeping
- Bone spurs causing a lumpy-looking joint
- Irritation of the nerves around the joint, causing tingling and numbness in the feet and toes
Diagnosing Ankle Arthritis
To make a diagnosis of ankle arthritis, your doctor will take a full medical history; it is important that you provide as much information about the pain you are experiencing, along with information regarding any injuries or previous infections you may have experienced. Your doctor will likely carry out a physical examination to understand where you are feeling the most pain, and when it is worse. They will examine the way you walk, assessing your cadence, speed and stride length. If your ankle hurts when you walk uphill, it may indicate arthritis in the front of your ankle; however, if it hurts when you walk downhill, this demonstrates a problem in the rear of the joint. If you are experiencing pain when you walk on uneven surfaces, this could be an indication of an unstable ankle. Instability and swelling often point towards weakened ligaments.
If your doctor feels further tests are required, you will be referred for diagnostic imaging which may include:
Images will be taken of your ankle from multiple angles whilst you stand on it, where a Radiologist will then examine your ankle alignment and the narrowing in your joint space.
Your doctor may also suggest a gait analysis test with a member of our Physiotherapy team. This involves walking or running on a treadmill whilst the physiotherapist observes. The doctor can then examine the rotation of your foot relative to your lower leg, providing information on how well your lower limbs and hips are performing.
Treatment of Ankle Arthritis
Your doctor will likely suggest conservative forms of treatment (non-surgical) before recommending surgery. These can include:
- Over the counter or prescribed painkillers such as ibuprofen, aspirin or anti-rheumatic drugs.
- Cortisone (steroid) injections can be provided for the management of more severe pain, particularly flare-ups. Steroid injections offer good pain relief, but it is important to bear in mind that they can only be administered 3-4 times a year as otherwise it can lead to a weakening of the muscles.
- Lifestyle modifications which involves avoiding exercises that impact on the ankle joint, including running and jumping. Opt for activities such as swimming which does not put any strain on the ankle.
- Wearing supportive footwear with cushioned inserts can help alleviate pain. A foot brace will help hold the ankle joint in position.
Preparing for Ankle Replacement Surgery
If conservative forms of treatment are not providing you with pain relief, and it is still impacting on your day-to-day life, your doctor will discuss the option of surgery with you. Before an agreement for surgery is made, the following considerations will be taken into account:
- How severe your symptoms are
- Other medical conditions you have
- Your age
- Your general wellbeing and level of activity
- Whether you have arthritis in other joints of your foot
Individuals who perform high impact activities are not considered good candidates for ankle replacement surgery. Ankle fusion surgery is seen as a better option.
Undergoing Ankle Replacement Surgery
You will be given a general anaesthetic which will put you to sleep so you do not feel any pain. Alternatively, a nerve block and sedative may be prescribed which means you will be awake during the surgery but again, will not feel any pain during the procedure.
The surgeon will make small incisions in the front and sides of the ankle and remove the damaged bone and cartilage. The ends of the tibia and talus are resurfaced, performed with precise instruments to create a level surface for the implanted prosthesis. The surgeon then places a metal and plastic implant into the bone ends to function as a new joint. This encourages the bone to grow into them so the foot can easily bend up and down.
The operation typically takes between 2-3 hours.
After the surgeon has finished the procedure, your incisions will be sutured (stitched) and your foot and ankle dressed and bandaged. You will likely be given a splint to wear that will give your ankle room to swell and protect you from injury. Your leg will remain number for up to 20 hours during and following surgery, after which you might feel some pain. However, you will be given pain relief to ease any discomfort.
You are likely to stay in hospital for 1-2 nights following surgery, although you will be up and moving again as soon as you can. You will be required to keep weight off your ankle for approximately 4-6 weeks, so you will need to use crutches or a walker during this time. You may be prescribed pain medication upon discharge; if not you can continue to take over the counter painkillers to help ease any discomfort you may still be experiencing.
Your medical team will provide you with instructions on how to take care of your dressings when you leave hospital. It is important that you keep them clean and dry, as you can increase your risk of infection if they get wet. You will be advised when you can start taking showers, although you might need to cover the dressing with a plastic bag to keep it dry. It is advisable to sit on a chair whilst you shower as you are likely to feel unstable in the first week or so. You will initially need someone to help out at home as you will be unable to do any housework or cook for yourself. You will also need time to rest and recover.
To accelerate your healing process, you will undergo physical therapy to help strengthen your ankle and improve range of motion. You will be provided with a set of exercises to perform at home once you have been discharged; it is important that you carry them out daily as otherwise you will experience stiffness in the joint.
After 4-6 weeks you should be able to resume your daily activities and return to work. However, if your job is physically demanding, you may have to wait longer before returning. You can begin to drive again once you can press down on the pedal without feeling any pain.
Risks and Complications
As ankle replacement surgery is a fairly new procedure, the main risks are due to the use of new technology with uncertain long-term results. Although uncommon, general complications following surgery include:
- Bleeding or blood clots
- Nerve injury
- Bones not fusing together properly
- Misalignment of bones
- New arthritis in neighbouring joints
- Wearing out of components
If you experience any of the following symptoms, you should call your doctor immediately:
- A foul smelling, yellow or green discharge
- A new onset of swelling, tingling pain or numbness in the toes that is not relieved by elevating your foot above your head for 1 hour
- A temperature above 38.5oC (101.3oF)
Outlook after Ankle Replacement Surgery
Ankle replacement surgery provides excellent pain relief and good function, although as with all joints, they can wear over time, resulting in a recurrence of symptoms.
At One Healthcare we can book you in to see a specialist Orthopaedic surgeon, usually within 48 hours, for an initial consultation. Ankle replacement surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Ankle Replacement Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience