It is critical for an ankle replacement to last that all deformity is corrected both within the ankle joint(this can be corrected with the ankle replacement) and outside the ankle joint(this can require additional procedures).
In most cases we are able to achieve this in one procedure and of course that is preferred by the patient.

 

Sometimes the deformity outside the ankle joint is too severe or too complex to be able to be corrected at the same time as the ankle replacement. In this situation, we need to separate it into two stages. Trying to do too much in one stage can mean an operation that takes too long with multiple incisions- this can increase swelling and compromise wound healing which can increase the risk of infection

 

The first stage is to correct the deformity outside the ankle joint. What this involves depends on the actual deformity and the correction can be both bony ( requiring osteotomies or fusions) and soft tissue (requiring ligament reconstructions/ tendon transfers) This will usually involve a standard recovery of 6 weeks non-weight bearing and 6 weeks weight bearing in a boot.

Even though this procedure does not directly treat the ankle arthritis correcting the deformity outside the ankle can improve the ankle arthritis pain so patients are often more comfortable at this point even though they are not pain free.

 

At this point we perform a prophecy protocol scan of the ankle so that we can begin planning for the total ankle replacement. A surgical plan is developed that I review and can modify if necessary. Once approved the patient-specific 3D jigs are produced so that they are available for ankle replacement surgery.

 

The second stage is usually performed 6 months after the first stage- this is to allow healing of the first stage to mature and gives the patient and their carers a little “mental break”. The ankle replacement is performed as per a standard ankle replacement with the same recovery period and protocol of 6 weeks non-weight bearing and 6 weeks weight bearing in a boot.

This two-stage approach allows us to provide an ankle replacement solution for patients with complex deformities associated with ankle arthritis that in the past could only be treated with a hind foot fusion. The outcome of an ankle replacement in this situation is far better than a hind foot fusion.

Whether a patient’s arthritis can be treated in one stage or two stages is determined by Dr. O’Carrigan based on his experience and the patient’s individual clinical presentation.