Yes, medical professionals perform ankle replacements, formally known as Total Ankle Arthroplasty (TAA). This orthopedic surgery is an established treatment option for individuals suffering from pain and limited mobility due to end-stage arthritis in the ankle joint. TAA involves removing the damaged surfaces of the tibia and talus bones and replacing them with an artificial joint composed of metal and plastic components. The procedure is designed to alleviate chronic pain while preserving movement, offering a solution for those who have exhausted conservative treatments.
Patient Criteria for Total Ankle Arthroplasty
The decision to proceed with Total Ankle Arthroplasty depends on a patient’s specific medical condition and overall health profile. The primary indication for TAA is end-stage arthritis of the ankle joint, resulting from trauma, osteoarthritis, or inflammatory conditions like rheumatoid arthritis. Surgery is considered only after non-surgical interventions, such as bracing, physical therapy, or injections, have failed to provide adequate relief.
The ideal patient is often over the age of 50, generally healthy, and has a lower physical demand level. They must possess good bone quality to support the prosthetic components and have minimal pre-existing deformity or instability. Conditions that prevent TAA include active infection, poor blood flow to the foot, uncorrectable malalignment, or advanced neuropathy. Diabetic patients must control blood sugar levels to reduce the risk of post-operative complications.
Ankle Replacement Versus Ankle Fusion
When ankle arthritis requires surgical intervention, the primary options are Total Ankle Arthroplasty (TAA) and ankle fusion (arthrodesis). Ankle fusion was historically the standard treatment, surgically joining the tibia and talus bones to eliminate all motion. This procedure provides long-term pain relief and stability by creating a permanently rigid structure.
The fundamental difference is joint mobility: TAA preserves motion, while fusion eliminates it. Maintaining movement allows an ankle replacement to more closely replicate a natural walking pattern. Preserving this motion also helps reduce mechanical stress transferred to adjacent joints, such as the subtalar and midfoot joints, which can develop secondary arthritis following fusion.
Fusion offers a durable solution often favored for younger, high-demand patients. TAA is preferred for individuals who prioritize retaining ankle flexibility, though the trade-off is the potential for the implant to wear out and require subsequent revision surgery.
The Surgical Procedure and Immediate Recovery
Total Ankle Arthroplasty is performed under general or regional anesthesia, beginning with an incision over the front of the ankle. Specialized instruments are used to precisely remove the damaged cartilage and a thin section of bone from the ends of the tibia and talus. The surgeon implants the metallic components onto the prepared bone surfaces, securing them with a press-fit technique or bone cement.
A polyethylene (medical-grade plastic) component is then inserted between the metal parts to act as the new bearing surface, allowing for smooth motion. Following surgery, the ankle is immobilized in a splint or cast. The patient must remain non-weight-bearing to allow soft tissues to heal and components to stabilize. The initial hospital stay is usually short, often one to two nights.
Recovery is progressive, starting with a non-weight-bearing period lasting between two and eight weeks. Physical therapy begins early to restore range of motion and strength. Patients transition to a walking boot and partial weight-bearing before moving to a normal shoe. Returning to daily activities takes three to six months, with maximum functional improvement spanning six to twelve months.
Long-Term Performance of Ankle Implants
The longevity of modern ankle implants has improved significantly due to advancements in materials and surgical techniques. Contemporary data suggests the average lifespan of a Total Ankle Arthroplasty device is between 10 and 15 years. Survivorship rates range from 70% to 90% at the 10-year mark, meaning most implants remain functional without needing replacement.
Several factors influence long-term success, including the patient’s activity level and body weight. Higher stress increases wear on the polyethylene component and can lead to earlier loosening of the metal parts. Revision surgery, where the implant or its components must be replaced, is a possibility; estimates suggest 10% to 20% of patients may require revision by ten years post-operation.
To maximize the life of the artificial joint, patients are advised to avoid high-impact activities such as running, jumping, and contact sports. Low-impact exercises, like swimming, cycling, and walking, are encouraged. Regular monitoring with a surgeon is necessary to track the implant’s condition and ensure proper alignment and stability.