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Overview

Ankle joint replacement surgery is a complex procedure recommended to patients suffering from acute ankle joint pain. It is also known as total ankle anthroplasty. Ankle joint pain can be caused due to either acute arthritis or a severe ankle injury. The treatment of arthritis in ankle generally starts with medication, like anti inflammatory medicines, braces or other support. Physical therapies to strengthen muscles around the ankle joint may also be prescribed to provide pain relief. In cases, medication and physical therapies don’t provide the desired outcome; lubrication injections may also be used. If all the above procedures fail to reduce the ankle joint pain and other symptoms, a surgery may be recommended. The two types of surgeries that can be recommended are ankle fusion and ankle replacement.

 

Ankle Fusion v/s Ankle Replacement

In ankle fusion, damaged bones are fastened together with metal plates and screws. During the healing process, the bones fuse into one another to form one combined bone. This surgery is very effective for reducing pain, but it reduces the ankle movement. To cope up with this reduced ankle movement, nearby joint have move more, which increases the chances of developing arthritis in these nearby joint.

In ankle replacement, the ends of the damaged bones are removed and are replaced by artificial joint implants. The implant is made up of metal and plastic. The artificial joint reduces pain as well as helps retain the ankle movement. However, ankle replacement has more risks than ankle fusion. And the results of replacement may not last as long as ankle fusion.

In general, ankle replacement is recommended to people above 60 years of age who don’t participate in high impact activities that may cause early wearing out of implants.

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Preparing for the Surgery

A good physical and mental health is the key for healing in any surgery. Before going for the ankle joint replacement surgery, it is advised to get a total physical checkup done by a general physician, to ensure physical well being. Blood thinning and anti inflammatory medicines are advised to be stopped one or two weeks before the surgery. After the surgery, the patient is not allowed to walk without support for few weeks. Proper arrangements, at home, must be made for the same.

The Surgery Procedure

The first step for the surgery is giving anesthesia to the patient. To keep patient pain free, the surgery is done either under general anesthesia or nerve block. During the surgery, a tourniquet may be used to control bleeding and improve visualization.

An incision (cut) is made at the front or side of the ankle, depending upon the type of implant used. The ends of the damaged bones are cut and the metal stem of the implant is inserted into the bone to recreate the ankle joint. Additional procedures, to ensure that the foot and ankle are aligned properly and to rectify the deformities, may also be performed. The incision is then stitched and a splint is applied. The splint is hard at back and soft in front. Splint is applied to give ankle room to swell and protect the ankle from injury.

The whole procedure takes around two and a half hours.

Recovering from the Surgery

The patient needs to be at the hospital for 2-4 days after the surgery. The effect of anesthesia, given at the time of surgery, lasts for around 18 hours. Patient may experience a slight pain after the effect of anesthesia goes off. Medicines are prescribed to reduce pain and avoid any post surgery infections. It is advised not to put weight on the ankle and to use crutches for several weeks after surgery. In case of severe pain or swelling after couple of weeks of the surgery, it is advised to visit the doctor at the earliest. After the surgical wounds have healed, patient is advised to do gentle exercises to improve the range of motion. However it is not allowed to put weight on the ankle for around two to three months from the surgery. It takes around an year to completely recover from an ankle replacement surgery and start doing all the normal activities.

Risks and Complications During and After the Surgery

The most common complications related to any surgery are:

  • Risks associated with anesthesia
  • Infections
  • Damage to tendons, nerves and blood vessel
  • Bleeding or blood clots, and
  • Fracture of bones on either side of the implant
Ankle replacement requires bones, on either side of the implant, to grow into the artificial joint so that the new joint can work properly. If this doesn’t happen, complications like ankle weakness, stiffness and instability may occur. Other probable complications are wearing out, loosening or dislocation of the artificial joint over time. In all of the above cases, patient may need an additional surgery to replace or remove the artificial joint or possibly get an ankle fusion.

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