Advanced ankle arthritis can be debilitating with pain and limited motion. Like with other joints with advanced arthritis, replacement is often suggested. What is ankle replacement surgery? What does ankle replacement recovery involve? Are ankle replacement surgeries successful? Are there better options? Let’s dig in.
Ankle Replacement Surgery
Ankle replacement surgery is the replacement of the damaged ankle joint with an artificial joint called a prosthesis. The damaged ankle joint, the lower part of the shin, and the upper part of the foot bone are surgically removed. A prosthesis is then inserted in the place of the damaged ankle joint. The prosthesis is typically compromised of both plastic and metal. Ankle replacement surgery is a treatment option for those with severe ankle arthritis with pain and restricted range of motion that have failed conservative therapies.
Ankle Replacement Recovery?
When considering any surgery you need to know not only what the surgery involves, but what’s expected after the surgery. So what does ankle replacement recovery involve? Following a 2 hour plus surgery under either general anesthesia or spinal anesthesia, patients typically spend 1-2 nights in the hospital. A plaster splint or boot is placed over the incision. While rehabilitation guidelines vary a walker or crutches are typically required for the 4-6 weeks. Progressive rehabilitation focuses on strengthening, balance, and gait. Return to driving is an important issue that has been examined in the literature. Varying ankle replacement recovery periods were proposed based on the type and severity of injury or surgery without a formal consensus (1). Braking function returns to normal 9 weeks after surgical repair of an ankle fracture (2). Typically no driving is recommended for 8-10 weeks after surgery during ankle replacement recovery.
Are Ankle Replacements Successful?
After the prolonged ankle replacement recovery, success can be difficult to quantify because of the different prosthesis used, time frames and variables evaluated. Of the 179 patients that underwent ankle replacement surgery only 15.2% of the patients said that their operated ankle was “normal” in a recent study (3). Pain scores and ankle function improved at 1 year independent of the type of prosthetic (4). Most concerning are the complications, onset of new degeneration in neighboring joints and the short life of the ankle prosthesis.
Ankle replacement complications include infection, prosthesis failure, loose prosthesis, nerve injury, bleeding, misalignment of the bones and new arthritis in neighboring joints. In a study of 306 patients who underwent ankle replacement surgery, 28% required additional surgery. Excessive bone growth, prosthesis misalignment and prosthesis failure were the three most common causes for additional surgery (5). Eight patients in the study underwent below-the-knee amputation. In a more recent study of 251 patients who underwent ankle replacement surgery, 3.2% had infections, 9.7% had fractures, 5.8% had loose prosthesis due to poor bone healing (6).
Adjacent Joint Degeneration
Trading in one problem for another is common in orthopedic surgeries. Spinal fusions are a classic example. Fusing one or more spinal segments places additional stress onto the spinal level above and below the fusion. This additional stress results in wear and tear and premature degeneration and injury. Unfortunately, this was also noted in patients that undergo ankle replacement surgery. In a study of 132 patients that underwent ankle replacement surgery, 19% developed arthritis in neighboring ankle joints (7). These new areas of arthritis can cause pain, restricted motion, and progressive degeneration of important joints in the feet.
Ankle Prosthesis Failure
A critical question is how long do ankle replacements last? The answer is disappointing. In a recent study of 780 patients who underwent ankle replacement surgeries, only 81% lasted 5 years and 69% lasted 10 years. Women with osteoarthritis and below the age of 60 were at a higher risk of requiring additional surgery when compared to other groups. (8). Unlike knee and knee replacements, ankle replacements do not last very long, and some patients will require additional surgeries.
Can You Run After Ankle Replacement?
High impact activities such as running may increase prosthesis degeneration and increase the incidence of fracture (9). Many surgeons discourage such activities following surgery (10).
Non Surgical Treatment Options
At the Centeno-Schultz Clinic we have extensive experience in the treatment of ankle injuries, arthritis and pain. PRP is effective in the treatment of ankle osteoarthritis (11). Stem cells treatments have also demonstrated clinical improvement in patients with ankle arthritis and pain (12). The best treatment is to address ankle injuries and pain before they progress. To learn more about the causes of ankle degeneration and treatment options please click on video below.
Ankle replacement is a surgical procedure where the damaged joint and cartilage are removed and replaced with artificial joint called a prosthesis. Ankle replacement recovery involves 4-6 weeks on crutches or a walker followed by extensive physical therapy. Driving is restricted for up to 8 weeks. Pain scores and function improve at 1 year. Ankle replacement has significant complications which include infection, prosthesis failure, loose prosthesis, nerve injury and bleeding. Neighboring foot joints are at risks for degeneration and injury. Most alarming is how short the prosthesis lasts and the potential for additional surgery, time out of work and rehabilitation. PRP and stem cells are effective non surgical treatment options for ankle pain.
1. MacLeod K, Lingham A, Chatha H, et al. “When can I return to driving?”: a review of the current literature on returning to driving after lower limb injury or arthroplasty. Bone Joint J. 2013;95-B(3):290-4. DOI: 10.1302/0301-620X.95B3.29540
2. Marecek GS, Schafer MF. Driving after orthopaedic surgery. J Am Acad Orthop Surg. 2013;21(11):696-706.DOI: 10.5435/JAAOS-21-11-696
3. Bonnin MP, Laurent JR, Casillas M. Ankle function and sports activity after total ankle arthroplasty. Foot Ankle Int. 2009;30(10):933-44. DOI: 10.3113/FAI.2009.0933
4. Usuelli FG, Indino C, Manzi L, Maccario C, D’Ambrosi R, Gross CE. Sport and physical activities in total ankle replacement: Mobile- and fix-bearing. Arch Trauma Res 2017;6:31-6
5. Spirt, Adrienne A., MD, PhD; Assal, Mathieu, MD; Hansen, Sigvard T. Jr., MD. Complications and Failures After Total Ankle Arthoplasty. JBJS: June 2004 – Volume 86 – Issue 6 – p 1172-1178
6. T. M. Clough, F. Alvi, H. Majeed. Total ankle arthroplasty: what are the risks? The Bone & Joint JournalVol. 100-B, No. 10. 8 Oct 2018https://doi.org/10.1302/0301-620X.100B10.BJJ-2018-0180.R1
9. Scott AT, Nunley JA. Polyethylene Fracture Following STAR Ankle Arthroplasty: A Report of Three Cases. Foot Ankle Int. 2009;30(4):375-9. DOI: 10.3113/FAI.2009.0375
10. Macaulay AA, VanValkenburg SM, DiGiovanni CW. Sport and activity restrictions following total ankle replacement: A survey of orthopaedic foot and ankle specialists. Foot Ankle Surg. 2015;21(4):260-5.DOI: 10.1016/j.fas.2015.01.014
11. Vannabouathong C, Del Fabbro G, Sales B, et al. Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review. Foot Ankle Int. 2018;39(10):1141-50. DOI: 10.1177/1071100718779375
12. Hurley ET, Yasui Y, Gianakos AL, et al. Limited evidence for adipose-derived stem cell therapy on the treatment of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3499-507. DOI: 10.1007/s00167-018-4955-x