Ankle Replacement

Your doctor may recommend ankle replacement to treat serious ankle damage when symptoms are severe or restrictive. This includes severe pain, deformity or disability, including difficulty walking. 

Ankle replacement is not a common surgery and is not the first choice to treat ankle problems. Your doctor will only consider ankle replacement if less invasive treatments do not improve your pain and ankle function. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend ankle replacement to treat severe or permanent ankle joint damage due to: 

• Ankle joint infection, also called septic arthritis

• Ankle joint injuries, including fractures, torn ligaments, and torn cartilage 

• Inflammatory forms of arthritis, including rheumatoid arthritis

• Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones

Orthopedic surgeons and foot and ankle surgeons perform ankle replacement. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Foot and ankle surgeons are orthopedic surgeons or podiatrists who further specialize in surgery of the foot, ankle, and lower leg. 

Your surgeon will perform your ankle replacement in a hospital. It involves making an incision in the front of the ankle to remove the damaged bones. This includes the ends of the lower leg bones and the top of the anklebone (talus). Your surgeon shapes and prepares the remaining bone to hold the new joint. Your surgeon then places an artificial ankle joint made of metal and plastic, tests the new joint, and secures it permanently in place.

Types of anesthesia 

Your surgeon will perform your ankle replacement using either general anesthesia or regional anesthesia. 

General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. 

What to expect the day of your ankle replacement

The day of your surgery, you can expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

• A surgical team member will start an IV.

• The anesthesiologist or nurse anesthetist will start your anesthesia.

• A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.

As with all surgeries, ankle replacement involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, which can block blood flow or travel to your lungs causing a pulmonary embolism

• Infection 
  

Potential complications of ankle replacement

Problems with ankle replacement are not common but include:

• Breakage or fracture of the new joint

• Loosening of the new joint causing pain and possibly requiring additional surgery to secure it

• Nerve or blood vessel damage

• Ongoing ankle stiffness and pain

• Wear and tear of the new joint requiring another replacement

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.

• Informing your doctor if you are nursing or there is any possibility of pregnancy

• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage

• Taking your medications exactly as directed 

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for an ankle replacement by:

• Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Arranging for a ride home after hospital discharge. It is also a good idea to have someone stay with you for the first 24 hours.

• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Performing ankle-strengthening exercises as directed before surgery

• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need ankle replacement? Are there any other options for treating my condition?

• If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?

• How long will the surgery take? When can I go home?

• What restrictions will I have after the surgery? When can I return to work and other activities?

• When will I start physical therapy? Where do I go for it? 

• What kind of assistance will I need at home?

• What medications will I need before and after the surgery? How should I take my medications?

• How will you treat my pain?

• When should I follow up with you? 

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect can help make your road to recovery after ankle replacement as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. You will likely stay several days in the hospital, depending on your condition.

You will likely wear a cast or splint and use crutches for up to 12 weeks. You will also have physical therapy to improve ankle strength and movement after surgery. You will need to avoid putting weight on your ankle for many weeks. Your surgeon will tell you when it is safe to return to your normal activities. 

Recovery after surgery is a gradual process. Recovery time varies depending on the type of anesthesia, your general health, your age, and other factors. Full recovery takes three to six months. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after ankle replacement. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Change in alertness, such as passing out, unresponsiveness, or confusion

• Chest pain, chest tightness, chest pressure, or palpitations

• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

• Inability to urinate or have a bowel movement

• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

• Numbness or tingling in the affected leg or foot

• Pain that is not controlled by your pain medication

• Unexpected drainage, pus, redness or swelling of your incision

How might ankle replacement affect my everyday life?

Ankle replacement can reduce ankle pain and improve ankle function so you can lead a more active, normal life. It can help you to be more independent and return to activities, such as walking, biking, and navigating stairs.

Ankle replacement can last 10 years if you are careful. You will need to protect your new ankle by avoiding:

• Contact sports

• Falls and activities with a high risk of falls, such as skating

• High impact or repetitive impact exercise and activities