Have Questions? Get the Facts about Ankle Replacement

Your physician will be able to answer questions specific to your situation. The following information is
for reference only and is not meant to provide a diagnosis of your condition.

Answers: The Ankle

Q: What is Ankle Arthritis?

A: Ankle arthritis is the progressive loss of the smooth gliding surface that lines the ends of the bones that form the ankle. This produces pain, stiffness, swelling and warmth at the joint. These detrimental effects lead to reduced comfort and endurance for standing and walking activities.

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Q: What is the Ankle Joint?

A: The ankle joint is located at the junction of the leg and the foot. It is made up of three bones: the tibia, the fibula and the talus. The ankle joint allows the foot to dorsiflex (point the foot up) and plantarflex (point the foot down). Normal ankle motion is part of the lower extremity joint complex that provides for shock absorption and energy conservation while standing and walking.

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Answers: The Procedure

Q: What is Ankle Replacement?

A: Ankle replacement is the surgical procedure used to expose the ankle joint, remove the diseased cartilage and bone and insert a metal and plastic bearing that reduces pain while maintaining ankle motion.

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Q: Am I a candidate for ankle replacement?

A: Only your surgeon can determine this. In general, healthy, non-diabetic patients with painful and disabling ankle arthritis that has failed to improve with non-surgical treatment are candidates for ankle replacement. Patients must have adequate skin coverage over the ankle, be infection-free both at the ankle and elsewhere, have normal sensation and muscle control of the foot and ankle. The ideal candidates are also older, have same side foot arthritis or opposite side ankle arthritis. A surgeon specialized in foot and ankle surgery can best evaluate your condition and determine if an ankle replacement is right for you.

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Q: What does the surgery involve?

A: After obtaining medical evaluation from your primary care provider you are admitted to the hospital for elective surgery. An anesthetic is placed and the ankle joint is exposed by careful separation of the tendons, vessels and nerves in front of the joint. The diseased portion of the ankle is precisely removed and the replacement is impacted into position. The layers are closed and a dressing is applied. Additional procedures may be performed at the same time as necessary. The procedure lasts 2 to 3 hours.

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Q: Why haven’t I heard much about ankle replacement?

A: When compared to the other major joints, arthritis of the ankle is uncommon. Many people know of someone who has found pain relief from hip or knee replacement, but few know someone who has had an ankle replacement. It is true that ankle replacement is not as common as hip and knee replacement, but the number of procedures is growing fast.

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Q: Who can perform this procedure?

A: As with any surgical procedure, experience matters. Ankle replacement is a complex procedure, and is best performed by a surgeon who specializes in foot and ankle surgery, and not just knee and hip replacement.

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Q: How long will I be in the hospital?

A: The typical patient spends one or two nights in the hospital after ankle replacement. However, the length of the hospital stay can depend on many other factors. Your surgeon will advise you on what he/she believes is likely for your specific situation.

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Q: Will insurance cover it?

A: Ankle replacement surgery is covered by Medicare and Medicaid as well as most private insurance companies. Your surgeon’s office will contact your insurance provider to determine coverage under your specific plan.

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Q: Am I too young to have ankle replacement surgery?

A: A foot and ankle surgeon who is experienced in ankle replacement surgery can evaluate your particular situation and determine whether you are a candidate for the procedure. All patients must exhaust other non-surgical treatment methods prior to proceeding with ankle replacement. No age limits have been established for ankle replacement, but the performance of a prosthetic joint and how long it will last depends on many factors, including the type of implant used, your physical condition, bone quality, activity level and lifestyle.

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Q: Are there any interactions to consider with current medications I’m taking?

A: It is very important that your surgeon be aware of all medications that you are taking, especially, steroids and blood thinners. You will be advised if you need to make any changes in your medication schedule. Generally, patients are advised to stop taking prescription or over the counter anti-inflammatory medication, including aspirin or ibuprofen five days before surgery. These medications thin the blood and can lead to excessive bleeding during surgery.

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Q: Will my ankle appear normal after the surgery?

A: The arthritic ankle is expected to be less swollen but not completely normal. Also, there will be a visible scar on the front of the ankle from the incision.

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Answers: The Device

Q: What is the ankle device made of?

A: There are several components that make up the ankle replacement device. All of the parts are made from highly biocompatible materials, including titanium and cobalt chrome metals on the tibial and talus sides of the joint. Between those two components, a third component made of a biocompatible plastic called polyethylene is attached to the tibial component to help the components glide against each other. These are identical materials to those used in hip and knee replacements. All of the materials have a long and successful track record for use in human joint replacements.

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Q: Is this a common procedure?

A: Advances in technology and materials have made ankle replacement more and more reliable. An increasing number of foot and ankle surgeons are using ankle replacement surgery with confidence to relieve pain and restore mobility in patients with compromised ankle function.

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Q: How many have been implanted?

A: Although still a small niche segment, the ankle replacement market is growing rapidly. In 2009, about 2,300 procedures were performed in the US alone.* The Salto Talaris total ankle prosthesis is the leader in that market.

* Millennium Research Group, 2009

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Q: How long does it last?

A: How long an ankle replacement lasts depends on many factors, including the type of implant used, and the patient’s physical condition, activity level and lifestyle. While prosthetic joints can provide increased mobility and pain relief for many years, it is a fact that they are mechanical bearings and may not last for the rest of the patient’s life. Most patients can expect their ankle replacement to last 10-20 years.

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Q: Are there different ankle implant options for men and women?

A: The components used for ankle replacement are not different for men and women specifically; what differs is simply the size of the components based on the patient’s anatomy. During the procedure, the surgeon carefully chooses the components that best match your ankle joint. The implants are available in a range of sizes and combinations for a customized fit.

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Q: Is my weight and activity level a consideration for ankle replacement?

A: Sedentary patients may be better served by an ankle fusion. Increased body mass index (BMI) is just one factor that will be carefully considered by your surgeon. Increased BMI can be associated with mechanical failure of the implant.

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Q: Are there any side effects or complications to having an implanted device in my ankle?

A: As with any surgery, there is always a risk of complications. Risks include nerve injury, vessel injury, tendon injury, bone injury, infection, failure and persistent pain.

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Answers: The Recovery

Q: Will I have pain?

A: All patients will experience some level of pain after surgery. Many patients are off prescription pain medication five to seven days after surgery. After the initial pain from the surgery subsides, you should not have any chronic pain as a result of the implant. You may have some soreness, but that will begin to improve in the weeks and months following surgery. Call your physician if you have any increased pain, swelling, fever or abnormal incision drainage.

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Q: How long is the recovery period?

A: Although the recovery program varies by patient and surgeon preference, many patients are in the hospital for 1 to 3 nights. The stitches used to close the incision are removed between 10 and 21 days after surgery. Once stitches are removed the patient is allowed to move the ankle. Bearing weight on the ankle is allowed 6 weeks after surgery, at that time, physical therapy is started to accelerate the resolution of swelling, pain and stiffness and to eventually improve strength and coordination. Protective devices such as a cast boot or brace, along with physical therapy, are discontinued 12 weeks after surgery. Your physician will schedule regular follow-up appointments with you during that time.

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Q: What is the physical therapy process?

A: Physical therapy is critical to the success of your new ankle. Your rehabilitation program often begins as early as the day of your surgery, when your health care team advises about the rehabilitation process. You will be instructed in the exercises to perform at home, which are designed to gradually increase the use of your ankle. It is important to follow your doctor’s instructions exactly and do your exercises regularly. In general, initial therapy involves stretching to help regain the normal ankle range of motion. Later, strengthening exercises are added if necessary. Your surgeon will provide you with any specific restrictions based upon your individual situation. It is important to follow those restrictions closely.

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Q: How soon can I return to normal activities after surgery and will I have any restrictions?

A: Most people are able to return to normal everyday activities such as dressing themselves and grooming within the first 2 weeks after successful ankle replacement surgery. Your ambulation will be restricted for 6-8 weeks until you start your rehabilitation therapy. Your doctor will advise you on specific limitations, including the amount of walking you can do on the ankle that was operated on. Many surgeons restrict their patient’s ambulation for a period of time. Your doctor will also let you know when you can begin ambulating more freely, and when you can return to other activities. Contact sports may be restricted in the long term.

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Q: What kind of help will I need?

A: Once you return home, it’s a good idea to have a family member or friend available to help you with daily activities such as washing, dressing and preparing meals. This is especially important during the first week or two following surgery. If you do not have home support, ask your health care provider about an agency or facility that may be able to provide the help you need.

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Q: How long until I can drive?

A: You must be off all pain medication before you consider returning to driving. Patients with minimal discomfort and access to a vehicle with an automatic transmission can usually return to driving about two months following surgery.

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Q: When can I return to work?

A: The decision to return to work is individualized and is influenced by your job, your employer and your post-operative course. In most circumstances, patients can return to office work in 2 to 3 weeks if accommodations are made for transportation, parking, office access, rest and foot elevation. Patients that perform physical work may return to work once they recover endurance for standing and walking, this is at least three to four months after surgery.

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Q: How long until I regain full use of my ankle?

A: The recovery of full ankle function may take up to 6 months, provided you followed the recommended physical therapy regimen. Most improvements are maximized by six months after surgery and residual swelling persists for 6 to 12 months.

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Q: What restrictions will I have using my ankle long-term?

A: People who have had an ankle replacement are generally advised to avoid contact sports and to refrain from repetitive impact activities that will accelerate wear of the implant, as these can place too much strain on your ankle implant. Consult your physician about the specific activities that might affect your new ankle.

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Answers: The Results

Q: How much will my range of motion improve?

A: It is impossible to state how much motion will recover after ankle replacement. However, patients with severely restricted motion that has been present for many years may be unable to achieve full motion despite a properly performed operation and dedicated physical therapy.

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Q: Is the pain going to go away?

A: Ankle replacement surgery can help you return to normal daily activities that were previously limited by the ankle disease. Even though the ankle replacement addresses the most likely pain source, other sources of pain remain in the ankle and foot. Pain is likely to be reduced but it is not always eliminated.

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Q: What happens if I wait to have my ankle replacement?

A: When ankle arthritis pain begins limiting your daily activities, causing you to lose sleep, and is not responding to other treatment alternatives, it may be time to consider ankle replacement surgery. By waiting too long, your range of motion can become severely limited, making the surgery more difficult and the results less certain. It is a good idea to discuss your condition early on with a foot and ankle surgeon, and learn about the options and timing that might be right for you.

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Q: What other treatment options are available to manage
my condition?

A: Early recommendations for arthritis treatment may include rest, walking with a cane in the opposite hand, over the counter or prescription anti-inflammatory medications, and medication for pain relief. Physical therapy may be prescribed in the early stages, although this can become less effective and even damaging as the arthritis advances. Cortisone injections can provide temporary relief of pain, although this is not generally considered a long-term solution. Occasionally, arthroscopic surgery is used to remove bone spurs and debris from the joint. When these solutions are not effective, your foot and ankle surgeon may discuss surgical alternatives with you, such as ankle fusion or ankle replacement surgery.

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