The ankle joint not only bears the weight of the body it allows for a complex range of motion.
Total ankle replacement (arthroplasty) is one of several treatments that may be prescribed when a person has rheumatoid arthritis of the ankle or a seriously injured ankle. Arthroplasty replaces bone and cartilage with an artificial joint made of metal and plastic. Ankle replacement is only done when pain-relieving drugs, physical therapy, changes in lifestyle, braces, special shoes or other treatments have failed to relieve severe pain and movement limitations.
Diagnoses
One of the most common reasons for a total ankle replacement is rheumatoid arthritis. Other conditions that may call for total arthroplasty include osteoarthritis, a severe bone fracture or complications from previous ankle surgery. Symptoms of these conditions include severe pain and difficulty moving the ankle joint. Because the ankle is a weight-bearing joint, these conditions can make it difficult for a person to have a normal life.
Ankle Arthroplasty
A total ankle replacement involves removing damaged cartilage and bone from the joint. The bones of the joint have to be reshaped to fit the artificial joint. These bones include the large bone (tibia) and small bone (fibula) of the shin and the foot bone (talus), which the tibia and fibula rest on. The artificial joint is then attached to the bones. Screws may be inserted into the tibia and fibula, or a bone graft may be done for more stability.
Alternatives
According to a 2003 position statement by the American Orthopaedic Foot and Ankle Society, total ankle arthroplasty should be considered as one among several options. Other options include smoothing the surfaces where the bones meet (debridement), fusing the bones of the ankle joint, removing bone and procedures aimed at restoring the bone and cartilage of the ankle. The best approach will depend on the patient, the patient's lifestyle and the condition of the joint.
Candidates
The best candidates for total ankle replacement are those who are older than 50, not overweight and not extremely active. It's possible to hike, ride a bicycle or even ski after a total ankle replacement. But people who are runners or do heavy labor are not good candidates for ankle replacement. People who have diabetes, nerve problems in their legs or poor circulation also are not good candidates.
Outcomes
A total ankle replacement will last about 10 years. While it restores some range of motion to the joint, it doesn't totally restore it. Total ankle replacements tend to be less successful than hip or knee replacements. People who have total ankle arthroplasty are more likely to develop infections from the artificial joint or to require follow-up surgery due to complications.
