Ankle Transplant

What is ankle transplant?

Ankle transplant involves the transplantation of the comoponent parts of the ankle from a deceased donor to a recipient whose own ankle joint is beyond repair. The allograft is size and age matched to the recpient. Unlike organ transplant, the bone and cartilage do not induce significant immunologic response and, over time, the donor bone will be replaced with the recipient’s bone. 

Indications and contraindications for ankle transplant

Ankle transplant is typically considered for:

Severe ankle arthritis: in which the joint’s cartilage has degenerated, causing deformity, subluxation (loss of normal joint alignment), pain and stiffness.

Post-traumatic arthritis: where injury has caused chronic instability. 

Failed prior reconstructive surgeries.

Young patients: those with good bone stock and good healing potential.

Patients unsuitable for ankle fusion or replacement.

Contraindications for ankle transplant include:

  • Severe osteoporosis or poor quality bone stock.
  • Avascular necrosis.
  • Active infection (local or general).
  • Vascular insufficiency.
  • Neuropathy.
  • Significant ankle deformity.
  • Poor general health.

Benefits and complications of ankle transplant

Benefits

  • Preserves more mobility than fusion. 
  • Provides relief from pain, especially for people with arthritis. 
  • Supports the ongoing health of neighbouring joints. 
  • No need for immunosuppresant therapies.
 
Known complications
 
  • Post-operative infection
  • Deep vein thrombosis (DVT) and pulmonary embolism.
  • Vascular injury and bleeding.
  • Transplant failure.

The surgery

Ankle transplantation is a complex procedure that requires careful planning and precise execution. Their surgical approach will be based on the patient’s condition, the need for accessory reconstructions, the quality of available grafts and the surgeon’s expertise. 

 

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 
 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general or regional anaesthesia.
  • An incision will be made over the ankle joint, which can vary in length depending on the complexity of the case.
  • Damaged cartilage and bone are removed and bespoke 3D-printed cutting jigs are used to create space for the transplant.
  • The transplant components are inserted and fixed into place using screws. The position of the transplant and screws is confirmed with x-rays.
  • If indicated, joint realignment or stabilisation is performed at the same time as ankle replacement.
  • The incision is closed using sutures. A dressing and cast are applied.  

 

After your surgery

  • In-patient care: you will remain in hospital for several days for monitoring and early-stage rehabilition. 
  • Pain and swelling: You may experience mild to moderate pain in the ankle. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum) and elevation.
  • Mobilising: you will wear your cast for 7 days after your surgery. This will be exchanged for a moon boot at your 7-day wound check. You will then wear this boot for a total of 12 weeks while your joint heals. For 6-18 weeks post-surgery, you will be unable to weight bear. Thereafter, you can begin to weightbear gradually, under close clinical supervision, provided the healing process is progressing normally. 
  • Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing.

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000