Ankle Replacement Surgery: Answering Pre-Operation Questions

Editor's Note: This article was originally written by Andrew Piasecki, M.D.

The main advantage of ankle replacement surgery is to relieve ankle arthritis pain and to preserve motion in the ankle joint. The alternative to ankle replacement surgery is ankle fusion. Ankle fusion is a more traditional surgery for ankle arthritis; in this procedure the cartilage is shaved off the bones of the ankle joint, which are then allowed to heal together. This eliminates the painful arthritic surfaces from rubbing on each other, however it comes at the expense of motion. Another downside of fusion of the ankle is that the ankle will be permanently stiff, and can lead to arthritis in adjacent joints. Ankle replacement surgery, however, can reduce this occurrence and allow motion of the ankle. Indeed, after ankle replacement surgery patients will be able to bear weight and walk without pain in the ankle. Most patients can resume daily activities without the use of pain medications .

While there are many pros to ankle replacement surgery, there are cons to consider as well. Specifically, ankle replacement surgery does include the usual risks associated with a surgical procedure, the potential need for future surgery, and a limited level of activity post-ankle replacement.

To elaborate, as with any major surgery, ankle replacement has the risk of infection, wound healing complications, as well as the potential for nerve damage, blood vessel damage, and bone breakage during surgery. There could also be a need for future surgery because of loosening of the artificial joint. Future surgery may include a revision of the replacement or a conversion to an ankle fusion. Another con to ankle replacement surgery is its level of durability. An ankle replacement cannot withstand running or jumping. As such, maintaining a reasonable level of activity should be followed or the ankle will not last long.

The primary reason for ankle replacement surgery is to relieve pain. The procedure can reliably provide excellent relief of arthritic pain and allow you to move your ankle up and down. In some cases, minor aches and pains associated with the level of activity may still occur. In general these aches and pains are significantly less than the preoperative pain.

Before undergoing ankle replacement surgery, there are several things that the patient should do to prepare. If you are a smoker, try to stop. Smoking can slow bone healing and increases the risk for wound healing complications . In addition, you will be asked to stop medications that can increase bleeding. Common medications that can do this include aspirin, ibuprofen, naproxen, Coumadin, and Plavix. If you have other medical conditions such as diabetes or heart disease , you will need to have a preoperative evaluation with your primary care physician.

This evaluation is done to minimize any potential medical complications. Always let your surgeon know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. You will also be asked not to take anything by mouth for 6-12 hours prior to your surgery; in some circumstances you might be instructed to take specific medications with a sip of water on the morning of surgery. Prior to surgery, you may be sent to physical therapy to learn certain exercises and undergo training to safely use crutches.

Recovery after the surgery usually involves a hospital stay of up to 4 days. Complete recovery can take 2-4 months, and a full recovery can usually be expected. Some patients will have minor pains during and after recovery, but generally their pain and function will be much improved.

It is important to remember that an ankle replacement does not last forever. Total ankle replacements can last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before the procedure. As previously mentioned in this article, another procedure may be required in the event of loosening or dislocation of the ankle implants from the bone. This is usually associated with the return of pain.
Only your orthopedic surgeon can determine whether you are an appropriate candidate for an ankle replacement surgery. For further questions about this surgery, consult with your physician.