If you have severe pain caused by ankle osteoarthritis (wear and tear), you’ve likely been putting up the problem for a long time.
Is your ankle painful and stiff, or have you been told you told you have ankle arthritis? Not sure if you should have an ankle fusion or ankle replacement? I'm here to help.
Why does ankle arthritis happen?
The commonest reason that wear happens within the ankle is previous trauma to the ankle, such as an ankle fracture. You may have experienced a nasty sprain, even years ago, that created some initial damage the joint surfaces, you may have experienced some instability in your ankle, or have kept going over on it.
Once the ankle is worn, it becomes painful and sometimes, despite physiotherapy, injections, or even keyhole surgery, you might find yourself with two options.
Either, you have a fusion of the ankle joint (which may be the best option for you), or, you might be suitable for ankle replacement surgery.
How is ankle osteoarthritis diagnosed?
When we meet, I’ll want to know all about how your ankle is affecting you, and what are the demands you place your ankle under (e.g. are you very active, retired, or finding it difficult to do your job? What your hobbies and past times are?) I’ll examine how you walk and how the ankle moves. You’ll undergo some X-rays (whilst standing), and perhaps an MRI or CT scan too.
Ankle fusion versus ankle replacement surgery.
In ankle fusion surgery, the worn surfaces of the ankle joint are burred away using keyhole surgery to raw bone and then large screws are placed across the joint to mechanically stop it moving. The ankle is fixed such that the foot is flat with the ground, and most patients who’ve been used to walking with a stiff ankle prior to the surgery, don’t walk with a limp after surgery, because there is still some flex within the mid foot.
Ankle replacement surgery is designed to give better and more natural range of movement for people who have ankle osteoarthritis, but it’s not for everyone.
What is ankle replacement surgery, and who is it suitable for?
The goal of ankle replacement is to treat your pain whilst maintaining mobility in your ankle.
Ankles are complex joints. They move in three different planes; you can flex your ankle up and down, but it also rotates too, which is why the earlier kinds of ankle replacements didn’t work very well.
Although ankle replacements are designed to withstand high loads, because of the small surface area involved they are more prone to failure than hip or knee replacements. So, if you intend to continue subjecting your ankle to high impact activities, you might be better served by a fusion surgery.
The people who do best are older patients (e.g. over the age of 65), and who have less demands on their legs. How your ankle has worn down is also very important. If your ankle has worse nice and evenly from left to right, then ankle replacements tend to last longer. If your ankle has worn out unevenly and there is a large tilt on your x-ray, then perhaps an ankle fusion may be a better option.
What happens during an ankle replacement?
I regularly say to my patients that ‘half of the operation is done online’. There’s a lot of planning that goes into an ankle replacement, and every patient has a tailor-made element to their replacement. I’ll ask you to go for a CT scan of your lower leg, and your images are then sent to a group of specialist design engineers in America. They construct the images into a 3D model, and I use that model online to determine the best implant size, position, rotation, and alignment precisely for your individual anatomy.
Once this process is done, and I have approved the final specifications, patient-specific cutting guides are made that only fit your ankle and no one else’s. This allows your ankle replacement to be implanted in the best most accurate way possible that is ideal for your specific anatomy only. The implant is called the ‘Prophecy’ and is manufactured by Wright Medical.
Because a large part of the operation is done before you even arrive in the operating theatre, this speeds up the operation and allows you to recover earlier with less pain and less side effects.
What’s it like to go through ankle replacement surgery?
The surgery takes place under a general anaesthetic, and you stay a night in the hospital. When you wake up, your leg will be numb for several hours. Your leg will partially be in plaster (a ‘back slab’) for two weeks. You won’t be able to weight bear on the ankle during this time, so you’ll either need to use crutches, a ‘strideon’ or an ‘iwalk’.
At two weeks, we meet again, and the cast will be removed, and you’ll go into a weight-bearing boot which you can take off at night-time. This is a good time to start some physiotherapy to get the ankle moving, and to start some gentle muscle-building exercises. You’ll be rather limited with your activities for around six weeks, whilst things heal up.
It will take several months before you can do activities such as tennis, and it’s best to avoid impact activity for the first six months, and it can take a good year for the ankle swelling to disappear, and for you to really reap the benefits. You will however notice that the arthritis pain has completely gone from day one.
How successful is ankle replacement surgery?
We talk about joint replacement success in terms of how long they last (or ‘survive’). A recent study showed that the 10 year survival rate for ankle replacements is around 85% - in other words, 85% of them are lasting at least 10 years. But these results include the older designs of ankle replacement. Further studies are ongoing all the time to understand what works best especially as more technology progresses.
If the ankle replacement eventually breaks down and fails, it may be possible to remove and replace the part that is the issue – either the top or bottom surface of the ankle replacement. Sometimes that’s not possible, and if so, a fusion operation is a good next option.
My replacement ankle operations performed by Mr Ajis was very successful. After 14 weeks I am walking with no limp for the first time in many years . I am playing golf again and with my hobby of walking , I'm up on the South Downs way again. I'm very pleased with with the result of my ankle operation and would recommend Mr Ajis and all the staff that I came in contact with.
I am very pleased with the result. My operation was explained well by Mr Ajis and from the time I came round in recovery afterwards, I have experienced no pain at all.
Prior to the operation I was in considerable pain for many months, so to be able to walk pain free now is wonderful.
Post operation was limiting with a plaster case for three weeks and then the special boot for another five weeks, but at the end I can walk normally and without pain. I am now undergoing phyiso to strengthen my muscles and look forward to long walks again.
I can only express my thanks and gratitude to Mr Ajis and his team for the new life this operation had given me.
I have found Mr Ajis to be very helpful and thorough when explaining procedures that he is carrying out.
Are you suffering from ankle pain?
Ankle pain can be distressing, especially if you're not sure what options are open to you. If you're wondering if surgery could help you, book an appointment.
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