Total Ankle Replacement

What is total ankle replacement?

Ankle arthroplasty, also known as ankle replacement, is a surgical procedure that replaces an arthritic ankle joint with artificial components. The primary goals of this surgery are to alleviate pain, restore function, and preserve ankle anatomy.

Indications and contraindications for total ankle replacement

Total ankle replacement is effective in the treatment of:

Osteoarthritis: A degenerative joint disease generally associated with ageing, congenital abnormalities of the knee joint, or prior trauma to the knee 

Rheumatoid arthritis: An inflammatory autoimmune condition resulting in accelerated degeneration of joint surfaces.  

Post-traumatic arthritis: Arthritis resulting from a previous injury or chronic joint instability. 

Contraindications for total ankle replacement include: 

Severe osteoporosis or poor quality bone. 

Vascular insufficiency, including avascular necrosis. 

Active infection (local or general).  

Neuropathy. 

Significant deformity of the component parts of the ankle.

Benefits and complications of total ankle replacement

Benefits

  • Relief from painful symptoms.
  • Restoration of function and improved mobility.
  • Preserves range of motion in the ankle joint.
  • Reduced joint stiffness.  

 

Known complications

  • Permanent nerve damage resulting in sensory or motor deficits.
  • Superficial or deep infection (< 1% of patients).
  • Vascular injury and bleeding.
  • Pain.
  • Implant loosening or failure 

  • Deep Vein Thrombosis (DVT)

The surgery

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 spinal anaesthesia.
  • An incision will be made over the ankle joint.
  • Damaged cartilage and bone are removed using bespoke 3D-printed cutting jigs to create space for the implant. 
  • The components of the artificial joint are inserted. X-rays are taken to confirm positioining.
  • The wound will be sutured and dressed. A cast will then be 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. 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 the first 6 weeks post-surgery, you will be unable to weight bear. Thereafter, you can begin to weightbear gradually, under close clinical supervision. 
  • 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