What is total ankle replacement?
Total ankle replacement or total ankle arthroplasty (TAA) is a surgical procedure used by orthopedic surgeons to treat ankle arthritis. This procedure is becoming the treatment of choice replacing the conventional use of arthrodesis or fusion of the bones. Restoration of range of motion afforded by TAA is the key advantage.
When deciding which surgery is right for you, be aware, when motion of the ankle is preserved in a TAA, the surrounding joints are protected from increased wear and, subsequently, arthritis. It’s common for patients undergoing ankle fusions to experience progressive arthritis in surrounding joints about ten to fifteen years after surgery.
Ankle arthritis occurs as a result of wear and tear due to aging. It can also result from injury. The objective of TAA is to improve ankle range of motion thereby reducing pain and allowing the patient to pursue normal activity.
When to consider TAA
TAA is considered in patients experiencing pain and limited function after trying non-invasive measures. These may include anti-inflammatory and pain medication, bracing, physical therapy and activity modification. Rheumatoid arthritis patients are usually good candidates as are those who need but don’t want a fusion-type procedure which would eliminate the range of motion of the joint. TAA is performed under general anesthetic or nerve block.
Convalescence from TAA is a lengthy and challenging process. An extended period of non-weightbearing and immobilization is necessary to insure proper healing. The patient will usually spend several nights in hospital. Leg elevation will be required for many days to keep swelling under control. When all wounds are healed, some gentle, range-of-motion activities may be permitted. Weightbearing doesn’t begin until X-rays show substantial healing, usually weeks after surgery.
In addition to the complications associated with all surgery such as problems with anesthesia, infection and nerve damage, TAA carries specific risks including bone fractures, and injury to tendons and blood vessels. Wound healing can also be problematic, especially for smokers and diabetics. Finally, it’s possible the implant will fail to heal into the bone. Nevertheless, ankle replacement surgeries are increasing, undoubtedly due to ever improving outcomes.