When movement in the ankle becomes a source of chronic pain due to late-stage arthritis, one of the few long-term solutions is total ankle replacement surgery. 

Total ankle replacement surgery has been in practice for over 40 years, but in recent years there have been rapid advancements in the procedure through technical innovation and improved techniques. Dr. Andrew Ertl is Sauk Prairie Healthcare’s Orthopedic surgeon with special training in foot and ankle surgery. Dr. Ertl is is one of the few specialists in the region offering total ankle replacement surgery. 

If you have persistent ankle pain and loss of function after exhausting conservative treatment options, total ankle replacement may provide a solution for long-term relief and get you back to an active lifestyle. 

Ankle Arthritis

Ankle replacement surgery is often used to treat ankle arthritis, which over time can result from wear-and-tear, injury, immune disorders, or lack of blood flow to the joint. 

Post-traumatic arthritis is the most common cause of chronic arthritis in the ankle. Post-traumatic arthritis is caused by a particular injury, which damages the cartilage that protects the bones at the joint or interferes with the alignment of the parts of the ankle. A traumatic injury can also cause the body to release hormones to the area that cause death of the cartilage tissue. 

Rheumatoid arthritis is an immunodeficiency that results in arthritis. Although the exact cause of the condition is unclear, it is thought to be a genetic issue that is sparked by an infection or environmental irritation. This causes the body’s immune system to attack the synovium, or soft tissue lining, between bones in the joint. This causes swelling and loss of critical space in the joint that otherwise allows for smooth motion. As friction in the joint increases, cartilage wears down until eventually bone is grinding against bone. 

Osteoarthritis, also known as degenerative joint disease, is one of the most common forms of arthritis in the shoulders, knees and hips, but lesser so in the ankle. It is often referred to as a “wear-and-tear” form of arthritis, caused by loss of cartilage from years of everyday stress. Like other forms of arthritis, in later and end-stage forms it causes pervasive pain, swelling, and loss of motion. 

Although damage caused by arthritis is permanent, symptoms are treatable. If you have late or end-stage arthritis and other treatments have been unsuccessful, your Orthopedic surgeon may recommend total ankle replacement surgery or ankle joint fusion surgery

Ankle Replacement Surgery Frequently Asked Questions

What Happens During Total Ankle Replacement?

During total ankle replacement surgery, the patient is given either general anesthesia and sleeps through the procedure, or a nerve-blocking epidural, eliminating feeling below the waist. 

A tourniquet is then applied to the leg to prevent blood loss during the procedure and the surgeon makes an incision at the side or back of the ankle. 

The affected bone is removed and replaced with three components made of plastic and metal: the polyethylene insert, a tibial component and a talar component. Together the three pieces will absorb the stress of the patient standing and walking, and provide motion similar to the ankle joint. 

Open ankle surgery is usually recommended as a last resort after more conservative methods have already been attempted. Orthopedic surgeons often suggest a minimum three months of conservative treatment before considering a joint replacement procedure. 

What are the Risks of Total Ankle Replacement Surgery? 

Before you make a decision about a surgical treatment you should discuss potential risks with your Orthopedic surgeon. The potential complications associated with ankle surgery vary with each patient. A patient who is also a smoker, for instance, will be prone to one possible complication, while a patient with poorly controlled diabetes would raise specific concerns of a separate complication. 

Following your initial recovery from ankle replacement surgery, your Orthopedic surgeon will see you in subsequent check-ups to be certain that there are no complications and that the prosthesis is in place and functioning properly. If a problem arises, a revision or replacement may be necessary. 

How Long is the Recovery from Total Ankle Replacement?

After surgery the patient often returns within two to three days of the surgery. The patient will need to use an aid, such as crutches, to stay off their ankle for four to six weeks. At about two weeks, they will return to the hospital to have stitches removed. 

After the initial period of a month to a month and a half of the ankle being in a cast, the first step toward mobility comes with the patient trading the cast for a splint or a boot, allowing them to begin placing weight on the new joint. 

At around the third month following surgery the boot will come off. Recovery will continue and after about a year the patient is often beginning to walk as they did before the surgery and returning to full activity. 

Although a patient may be able to return to walking unaided and carrying on with most activities, they will be cautioned against high-impact sports like jogging or basketball, which involve more stress and force than the prosthetic can reliably absorb. 

When Should I Have Ankle Replacement Surgery? 

Your Orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, X-rays, and response to conservative treatment. The decision of how to proceed will then be yours. 

Age is generally not a factor if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery. 

Expectations of Total Ankle Replacement at Sauk Prairie Healthcare

When you have a total ankle replacement surgery at Sauk Prairie Healthcare you will be actively involved in your treatment through each step of the process. Care providers will work with you from the preparation stage, to education, continuity of care and finally a pre-planned discharge, all being key to successful treatment and recovery. 

Fellowship-Trained Foot and Ankle Surgeon:
Andrew M. Ertl, MD

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