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What is ankle replacement surgery?

In a total ankle replacement, also known as total ankle arthroplasty, a damaged ankle joint is replaced with an artificial one in order to relieve the pain of ankle arthritis and improve ankle motion. The surgeon will remove the ends of the bones and insert a joint made of plastic and metal. As you heal, your own bone will grow into the new joint, allowing it to function much like a natural ankle.

Why it's done

If you have reduced mobility and significant pain because of arthritis in the joint and conservative treatments haven’t helped, it can make sense to consider both total ankle replacement and ankle fusion. The decision whether to get one of these procedures—and, if so, which—should be guided by a number of factors.

In an ankle fusion, also known as arthodesis, the damaged cartilage is removed from the ends of the ankle bones, which are then allowed to grow together. This relieves pain by limiting movement of the joint. However, other nearby joints may respond by moving more, which can eventually raise the risk of developing arthritis in those areas.

With ankle replacement surgery, the ankle retains more mobility, which reduces the likelihood of arthritis in neighboring joints. The results of ankle replacement may not last as long as those of ankle fusion, though. For that reason, ankle replacement is more likely to be recommended for individuals who are over 60 and who don’t participate in high-impact physical activities.

Complications

Like any surgery, total ankle replacement carries risks, such as the possibility of infection, bleeding, blood clots, nerve damage and problems associated with anesthesia. In addition, the bone on either side of the implant may fracture, although this is rare. Other risks include a loosening of the artificial joint over time, or the bone failing to grow into the joint. If either of these occur, you may need another surgery to replace the artificial joint, or to remove it and fuse the ankle joint instead. 

What to expect

Total ankle replacement may be done either under general anesthesia or a nerve block. During the procedure, your surgeon will expose the ankle joint, remove the damaged bone at the end of the shin bone (tibia) and the foot bone (talus), and insert the metal and plastic joint. If your calf muscle or Achilles tendon is tight, the surgeon may lengthen it in order to improve the ankle’s range of motion. The surgeon may use screws to stabilize the new joint and keep it positioned properly.

Recovery

Total ankle replacement is usually done on an inpatient basis, and you will likely spend a night or more in the hospital.

In the days after surgery, it is important to keep your foot elevated as much as possible in order to reduce swelling. A cast or splint will keep your ankle immobilized.

Once the incision heals, you’ll be able to begin gentle range-of-motion exercises. However, you won’t be able to put any weight on your ankle for several weeks.

To protect your ankle and allow for healing, you may need to wear a brace or splint for up to three months. It may take as long as a year to return to full activity.

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