A total ankle replacement is performed to relieve the pain and correct the deformity caused by ankle arthritis. Ankle arthritis is where the cartilage in the ankle is worn out causing pain, stiffness and progressive deformity.  Ankle arthritis is not as common as knee or hip arthritis, but it affects people's lives just as much.  It causes pain with day-to-day activities which can become severe, affecting your quality of life and mental health.

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An ankle replacement, like a knee or hip replacement replaces the worn-out joint surfaces with metal and plastic components that correct deformity, relieve pain and preserve movement.

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An ankle replacement is done under a general anesthetic. My Anaesthetist does an ankle block using an ultrasound machine to increase the accuracy. This provides excellent pain relief for the first 24 hours after the surgery. A tourniquet is applied to the leg and the leg is prepped and draped in a standard manner.

A surgical approach to the ankle from the front is performed and this exposes the ankle joint. Using the X-ray machine in theatre a jig is applied that allows accurate cuts to be made on the bottom of the tibia and other instruments allow the preparation of the talus.

A metal plate with a roughened surface on the tibial bone side and a smooth surface on the joint side is inserted. This provides initial stability, but long-term stability is achieved by the bone growing onto the metal component. A similar metal cap is applied to the top of the talus and then a plastic insert (same special plastic used in knee and hip replacements) is inserted between the metal components.

Alignment, soft tissue balancing, and stability are all checked and then the wound is closed in layers and a plaster back slab (not a full cast) is then applied.

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Advantages of an ankle replacement?

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1. It relieves pain just like the ankle fusion.

2. It preserves movement, Joints are designed to move, and it is much better to relieve pain and preserve movement. Ankle replacements do not usually restore normal movement like the patient had when they were young but even preserving small amounts of movement assist with walking more normally and reducing pressure on surrounding joints because of stiffness.

3. More normal walking - gait studies have shown that a good ankle replacement is better at restoring normal gait than a good ankle fusion, but the difference is somewhat subtle.

What are the disadvantages of an ankle replacement?

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1.  Ankle replacements are not suitable for all cases of ankle arthritis. A fusion is better if there is:
   a.  A history of infection
   b. Inadequate soft tissue envelope- severe scarring/adherent skin graft/soft tissue stiffness can make a total ankle replacement too risky.
   c.  Patient is under 40 years old; an ankle Fusion may be a better choice for the medium to long term.
    

2.  Ankle replacements don’t last forever. As time progresses, we are getting more confident with the potential longevity of ankle replacements and our revision options are improving but historically the revision rate for ankle replacements is higher than total knee or hip replacements. There are many factors that influence this the discussion of which is beyond the scope of this article. The age of a patient has to be considered along with the potential requirement for a revision in the future when one is considering a total ankle replacement.

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