Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by the gradual breakdown of cartilage in the joints and the underlying bone. It is one of the most common forms of arthritis and often affects weight-bearing joints such as the knees, hips, and spine, as well as the hands and feet (ankle). OA is a leading cause of disability, and its impact on daily activities can be significant.
How Common It Is and Who Gets It? (Epidemiology)
OA affects millions of people worldwide and is most common in adults over the age of 50. However, it can also affect younger individuals, particularly those with a history of joint injuries, obesity, or genetic predispositions. Weight-bearing joints like the knees, hips, and spine are most commonly affected, but the hands and feet, including the ankle, can also be involved.
Why It Happens – Causes (Etiology and Pathophysiology)
Several factors contribute to the development of OA, including:
- Age: The risk increases with age due to the natural wear and tear of joint cartilage.
- Genetics: A family history of OA can increase the likelihood of developing the disease.
- Joint Injury or Overuse: Previous joint injuries or overuse can accelerate cartilage breakdown.
- Obesity: Excess body weight puts added pressure on weight-bearing joints, leading to increased wear and tear.
- Other Health Conditions: Conditions like metabolic disorders and inflammatory diseases can contribute to the development of OA.
How the Body Part Normally Works? (Relevant Anatomy)
The ankle joint consists of the tibia, fibula, and talus, which are covered with cartilage to provide smooth, pain-free movement. In OA, this cartilage deteriorates over time, leading to pain, swelling, and reduced function in the joint. As the condition progresses, the underlying bone can also become affected, leading to further pain and decreased range of motion.
What You Might Feel – Symptoms (Clinical Presentation)
Common symptoms of OA in the ankle include:
- Pain: Typically worsens with activity and improves with rest.
- Stiffness: Reduced range of motion, especially after periods of inactivity.
- Swelling: The ankle joint may become swollen and tender to touch.
- Bone Spurs: Over time, bone spurs (osteophytes) can form around the joint, further restricting movement.
How Doctors Find the Problem? (Diagnosis and Imaging)
The diagnosis of OA is made through a combination of medical history, physical examination, and imaging tests:
- Medical History: The doctor will inquire about symptoms like pain, stiffness, and difficulty walking.
- Physical Examination: The doctor will assess joint function, swelling, and range of motion.
- Imaging: X-rays are typically used to confirm the diagnosis, showing joint space narrowing, bone spurs, and cartilage degeneration. An MRI may be used in certain cases for a more detailed view of the soft tissues.
Classification
OA is typically classified based on its severity, with stages ranging from mild (early cartilage wear) to severe (joint deformity and loss of function). The degree of functional impairment depends on the stage of the disease and the affected joint.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions such as rheumatoid arthritis, gout, tendonitis, or ligament injuries can present with symptoms similar to OA. Differentiating OA from these other conditions is important for selecting the appropriate treatment.
Treatment Options
Non-Surgical Care:
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- Weight management to reduce stress on the joints.
- Physical therapy to strengthen muscles around the joint and improve range of motion.
- Pain management with NSAIDs, acetaminophen, or topical treatments.
- Joint injections with corticosteroids or hyaluronic acid to reduce inflammation and lubricate the joint.
Surgical Care:
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- Total ankle replacement (TAR) is a surgical option when non-surgical treatments fail to provide relief. TAR involves removing the damaged ankle joint and replacing it with an artificial implant.
Recovery and What to Expect After Treatment
Post-surgery, patients are typically placed in a cast or boot to immobilize the joint for several weeks. Gradual weight-bearing and rehabilitation are introduced after the initial healing phase. Full recovery from total ankle replacement typically takes 6 months to a year, depending on the individual’s healing progress.
Possible Risks or Side Effects (Complications)
- General Risks: Infection, blood clots, and scarring are potential risks with any surgery.
- Specific Risks: For TAR, complications include implant failure, loosening of the implant, and limited range of motion.
- Postoperative Rehabilitation: Complications like stiffness or chronic pain can arise if rehabilitation is not followed properly.
Long-Term Outlook (Prognosis)
For those undergoing total ankle replacement, the outlook is generally positive. The procedure significantly improves pain levels, range of motion, and quality of life. Studies show that TAR can provide relief from pain and improve function for up to ten years, though some patients may eventually require revision surgery.
Out-of-Pocket Cost
Medicare
CPT Code 27702 – Total Ankle Replacement (Ankle Arthroplasty): $226.36
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover the remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient costs.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your total ankle replacement is required due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, postoperative care, and rehabilitation. You will not have any out-of-pocket costs, as the employer’s insurance carrier pays directly for all approved treatments.
No-Fault Insurance
If your total ankle replacement is needed because of an automobile accident, No-Fault Insurance will generally cover the full cost of your treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
Rachel Matthews had severe arthritis in her ankle and underwent total ankle replacement (CPT 27702). Her estimated Medicare out-of-pocket cost was $226.36. Since Rachel had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is Osteoarthritis (OA)?
A. OA is a degenerative joint disease that causes the breakdown of cartilage in the joints, leading to pain, stiffness, and reduced function.
Q. What are the main causes of OA?
A. Age, genetics, obesity, joint injury, and other health conditions contribute to the development of OA.
Q. How is OA diagnosed?
A. Diagnosis is made through medical history, physical examination, and imaging tests like X-rays or MRIs.
Q. What are the symptoms of OA?
A. Common symptoms include joint pain, stiffness, swelling, and reduced range of motion, especially with activity.
Q. What is Total Ankle Replacement (TAR)?
A. TAR is a surgical procedure that involves removing the damaged ankle joint and replacing it with an artificial implant to restore movement and reduce pain.
Q. How long does recovery take after TAR?
A. Recovery from TAR typically takes 6 months to a year, depending on the individual’s healing process.
Q. What are the risks of TAR surgery?
A. Risks include infection, implant failure, and limited range of motion. Rehabilitation is crucial for a successful recovery.
Q. How effective is TAR for OA?
A. TAR is highly effective, with most patients experiencing significant pain relief and improved mobility for up to 10 years.
Q. Can OA be prevented?
A. While OA cannot be entirely prevented, maintaining a healthy weight, exercising, and avoiding joint injuries can help reduce the risk of developing the condition.
Q. What are the treatment options for OA?
A. Treatment includes lifestyle changes, physical therapy, pain management, joint injections, and, in severe cases, surgery like TAR.
Q. Can OA be cured?
A. There is no cure for OA, but treatments can help manage symptoms and improve quality of life.
Q. What is the role of physical therapy in OA treatment?
A. Physical therapy helps strengthen the muscles around the affected joint, improving mobility and reducing pain.
Summary and Takeaway
Osteoarthritis is a degenerative joint disease that primarily affects weight-bearing joints, causing pain, stiffness, and reduced mobility. Total ankle replacement (TAR) is an effective surgical option for patients with advanced ankle OA, significantly improving pain, function, and quality of life. With proper diagnosis, treatment, and rehabilitation, patients can achieve long-term relief and return to normal activities.
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons specializing in foot and ankle surgery perform TAR. In some cases, a multidisciplinary team, including physical therapists and rehabilitation specialists, may be involved in postoperative care.
When to See a Specialist?
If you are experiencing persistent ankle pain, stiffness, or difficulty walking due to osteoarthritis, it’s important to consult a specialist to determine if TAR or another treatment option is necessary.
When to Go to the Emergency Room?
You should seek emergency care if you experience severe pain, sudden loss of function, or a traumatic injury to the ankle that may require immediate attention.
What Recovery Really Looks Like?
Recovery from TAR involves several months of rehabilitation. Initial non-weight-bearing is followed by gradual weight-bearing and physical therapy. Full recovery may take up to a year, depending on individual healing progress.
What Happens If You Ignore It?
Ignoring OA can lead to worsening pain, decreased mobility, and potential joint deformities. Early intervention with treatments like TAR can prevent further damage and improve quality of life.
How to Prevent It?
Maintaining a healthy weight, exercising regularly, and avoiding joint injuries can help prevent or reduce the progression of OA.
Nutrition and Bone or Joint Health
A diet rich in calcium and vitamin D supports bone health, which is essential for managing OA. Maintaining a healthy weight also reduces strain on the affected joints.
Activity and Lifestyle Modifications
After surgery, low-impact exercises such as swimming or cycling are ideal for maintaining fitness without stressing the ankle joint.
Do you have more questions?
What anesthesia is used for ankle replacement surgery?
Ankle replacement surgery is usually carried out with regional anesthesia, which numbs the leg. Patients are given medication to induce sleep during the procedure, but they remain partially conscious and not fully unconscious.
Will hospitalization be required after ankle replacement surgery?
The majority of patients can go home on the same day following the procedure, although a few may need to stay overnight.
What is the typical recovery schedule for ankle replacement surgery?
During the recovery period, it’s important to keep the leg elevated and avoid putting weight on it for the initial four weeks. Physical therapy typically starts after four weeks, along with gradually walking in a supportive boot. Transitioning to regular shoes usually occurs around eight weeks, although complete recovery may take up to a year.
How soon after the surgery can driving be resumed?
Typically, driving can resume after about eight weeks following surgery on the right ankle, and possibly earlier if the left ankle was operated on.
Is assistance required at home during the healing process?
Support or assistance is advised during the initial two weeks following surgery since the foot cannot bear weight during this time.
When can regular activities be resumed?
Following the initial four weeks, patients can start engaging in limited activities, gradually progressing to more demanding tasks over the course of six months to a year.
What are some of the advantages and potential drawbacks of ankle replacement?
The advantages comprise pain alleviation and retained ankle mobility, facilitating more natural walking. Potential risks encompass infection, blood clots, and gradual loosening of the prosthetic components.
What steps should be taken to prepare for ankle replacement surgery?
Preparation may entail undergoing physical therapy, quitting smoking, and discontinuing specific medications as advised by the healthcare provider.
What physical therapy is necessary after the surgery?
Physical therapy plays a vital role in the recovery process, involving exercises such as open-chain isotonic movements, proprioceptive exercises, and gradually progressing to weight-bearing activities.
Are there any lasting restrictions following ankle replacement surgery?
Patients are advised to steer clear of high-impact activities like running or jumping but can participate in walking, hiking, and low-impact sports.
Total ankle replacement typically leads to substantial pain reduction and retained mobility, with the majority of patients expressing satisfaction with the results of their procedure.
What is the process for performing total ankle replacement surgery?
During the procedure, the surgeon makes an incision at the front of the ankle to access the affected area. Damaged bone and cartilage are then removed, and prosthetic components are inserted to mimic the natural joint.
Which conditions commonly result in the necessity for ankle replacement surgery?
Serious arthritis, notable ankle discomfort, and restricted mobility frequently prompt consideration for ankle replacement surgery.
How can I determine if I am eligible for ankle replacement surgery?
A comprehensive assessment conducted by an orthopedic surgeon, which includes reviewing medical history, performing a physical examination, and analyzing imaging results, is essential to ascertain candidacy.
What other treatment options are available for advanced ankle osteoarthritis?
Other options include conservative approaches such as pain medication, braces, injections, as well as surgical interventions like ankle fusion or arthroscopy.
What is the typical lifespan of an ankle replacement prosthesis?
The durability of a prosthesis varies but can extend to 10 years or beyond, influenced by factors such as activity level and weight.
What components are utilized in ankle replacement implants?
Implants are commonly crafted from metal alloys and plastic (polyethylene) to offer robust and smooth surfaces for articulation.
Is it possible to undergo ankle replacement surgery more than once if the initial prosthesis fails?
Revision surgeries are feasible but tend to be more intricate and contingent upon individual circumstances.
What sets ankle replacement surgery apart from ankle fusion?
Ankle replacement maintains joint motion, whereas fusion stops joint movement to alleviate pain.
What are the lasting advantages of selecting ankle replacement surgery compared to other treatments?
Are there any age limitations for undergoing ankle replacement surgery?
While there are no rigid age restrictions, one’s overall health and level of physical activity are crucial factors to consider.
What specific tests are typically needed before undergoing ankle replacement surgery?
Examinations usually involve blood tests, imaging scans, and occasionally specialized assessments of the heart or lungs.
What adjustments should I make to my home environment to facilitate recovery after ankle replacement surgery?
Changes may involve removing potential tripping hazards, installing grab bars, and ensuring there’s a comfortable recovery area on the ground floor.
Are there specific dietary guidelines to adhere to before and after ankle replacement surgery?
A well-rounded diet rich in protein and essential vitamins is typically advised to promote healing.
What methods can I use to alleviate pain following ankle replacement surgery?
Pain relief methods may involve medications, icing, elevation, and subsequently, physical therapy.
What symptoms should I watch for that may indicate an infection following the surgery?
Symptoms such as redness, excessive swelling, fever, or drainage from the incision site could suggest the presence of an infection.
How often will I need to attend follow-up appointments after ankle replacement surgery?
Follow-up appointments are usually scheduled at regular intervals, such as every six weeks, three months, six months, and annually thereafter.
What types of shoes are recommended following ankle replacement surgery?
It is advisable to wear supportive and comfortable shoes, especially ones that can accommodate swelling.
Are there any limitations on traveling after ankle replacement surgery?
Travel might be restricted initially due to swelling and the necessity for elevating the leg; it’s advisable to seek guidance from your surgeon.
What impact do comorbid conditions such as diabetes have on the outcomes of ankle replacement surgery?
Underlying health conditions can heighten the risk of complications and potentially influence the healing process.
Is it safe to undergo an MRI after having an ankle replacement?
Usually, yes, but it’s important to inform the MRI technician about your implant beforehand.
What symptoms might indicate that an ankle replacement is not functioning properly?
Signs of a failing replacement may include heightened pain, diminished mobility, or instability.
What impact does body weight have on the results of ankle replacement surgery?
Increased body weight can elevate the strain on the implant, potentially resulting in a reduced lifespan for the replacement.
What are the success rates associated with total ankle replacements?
The success rates are typically high in providing pain relief and enhancing function.
Are there any recent developments or advancements in ankle replacement surgery that I should be aware of?
Advancements in prosthetic design, surgical methods, and postoperative care are continually evolving. It’s recommended to consult with a surgeon to explore the most recent options available.
How can I select the most suitable surgeon for my ankle replacement surgery?
Seek out a board-certified orthopedic surgeon with expertise in ankle replacements, and review their history of patient outcomes for reassurance.
How does physical therapy contribute to the recovery process following ankle replacement surgery?
Physical therapy plays a vital role in recovering strength, mobility, and function after surgery.
Is ankle replacement surgery typically performed on an outpatient basis?
Although most cases are performed on an inpatient basis, some patients may qualify for outpatient surgery depending on their overall health and individual circumstances.
What anesthesia options are available for ankle replacement surgery?
Choices usually involve general anesthesia or regional anesthesia combined with sedation.
For how long will I require the use of assistive devices such as crutches or a walker after surgery?
Assistive devices are typically required for the initial four to eight weeks, depending on the patient’s rate of recovery.
What lifestyle adjustments will be necessary following an ankle replacement?
Refrain from engaging in high-impact activities and focus on maintaining a healthy lifestyle.
What is arthritis?
Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs. Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery. It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.
What is ankle arthritis?
Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.
What causes ankle arthritis? How do you get arthritis in your ankle?
In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia. In many of these cases, an initial fracture/impaction injury results in uneven force dissipation across the ankle joint. This causes the ankle to be overloaded in certain area. After years of walking on this unevenly distributed joint, the cartilage starts to wear thin, and inflammation ensures.
Is ankle arthritis common? How common is ankle arthritis?
Ankle arthritis is less common that larger weight bearing joints such as the knee or hip. The incidence of ankle arthritis is approximately 30 per 100,000 people. Global approximation is roughly 1% of the population.
What does arthritis in ankle feel like?
Often patients will experience pain around ankle joint. This is most commonly with weight bearing, walking, or exercises. Swelling at the joint line is very common. Over time the joint will become stiff, and range of motion will be lost. If this goes on long enough, the alignment of the joint will change, and a progressive deformity will ensue. The natural history of all arthritis is to slowly and chronically progress, with worsening pain exacerbation episodes.
How do you diagnose ankle arthritis? how is ankle arthritis diagnosed?
A surgeon will obtain a thorough history and perform a physical examination. If there is a convincing clinical presentation, we will confirm our suspicion with X-rays and advanced imaging. Additional testing may be required.
Does ankle arthritis show up on X-ray?
Yes. Most of the time we are able to detect arthritis on X-rays. In the cases of very focal disease, or early arthritis, additional advanced imaging may be required (MRI / CT scans).
What does ankle arthritis look like on an X-ray?
Ankle arthritis will show up as narrowing of the joint space at the ankle joint line. There may also be formation of new bony spurs. In severe cases the ankle will start to drift medially or laterally, resulting in deformity.
What surgery is done for ankle arthritis?
Once all non-operative options have been exhausted, and you are no longer able to cope with ankle arthritis, surgical options are indicated. Continue reading for further information on how surgery can be helpful for treating ankle arthritis. There are many surgical approaches to treating ankle arthritis. This depends on several factors. This can be patient factors such as underlying medical conditions, level of activity, goals of treatment, and expectations. Joint related factors also come into play. This includes how severe the arthritis is, whether there localized or global disease, severity of arthritis, presence of deformity, and involvement of surrounding soft tissue structures. Furthermore, concomitant foot deformity must also be considered. Early ankle arthritis, that is well localized, in young active healthy patients, is amenable to debridement with ankle arthroscopy. This is a minimally invasive procedure where a camera is inserted into the joint, and areas of arthritis are debrided away. This can provide pain relief, more range of motion, and long-term symptom control for patients with early ankle arthritis. See the ankle arthroscopy section for more information regarding these options. Speak to one of our experts if you think you may be a candidate. More extensive arthritis is typically treated with two main options: fusion (arthrodesis) or replacement (arthroplasty). Both options have their benefits and pitfalls. It is critical to have a discussion with your surgeon to determine which option is right for you. Ankle fusion (arthrodesis) is considered the gold standard for cases of severe ankle arthritis. It has been the go-to procedure for decades. Here we expose the joint, remove any residual cartilage, and oppose the talus bone to the end of the tibia bone. These two bones heal to one another, forming one bony structure. Functionally the joint is eliminated. There is no motion across the joint anymore. However, there is also no pain. Ankle replacement (arthroplasty) is a newer procedure that has been advancing quickly over the last 2 decades. Replacement surgery is much more involved than ankle fusion. It provides pain relief similar to fusion surgery. However, it allows us to maintain motion at the ankle joint. This is thought to prevent neighboring foot joints from deteriorating. The recovering and healing form this is more difficult. Ask one of our experts if you are a candidate for one of these procedures.
How is ankle replacement done? How does ankle replacement work? What takes place in a total ankle replacement? What would constitute a total ankle replacement?
In order to perform an ankle replacement, we often will utilize advanced imaging and patient specific instruments. This requires a CT scan before the procedure. Custom cutting jigs will be 3D printed. These improve the location of bony cuts and reduce operative time. We make an incision in the front of your ankle, avoiding nerves and vessels. We dissect down to the joint, preserving soft tissues. We apply and secure 3D printed custom cutting jigs. These are secured. We then cut the tibia and talus to accommodate metal implants. Once cuts are made, we remove excess bone and debris. We apply trial implants to ensure sizing and tension. Once we have determined the correct size implants, we place metal components in the tibia and talus. We then place a high-density polyethylene component. At this stage we stress test the ligament structures. If there is ligament deficiency, we may perform a reconstruction acutely, or stage this to a later time. Similarly, if there is a foot deformity this may be addressed at the time of surgery or staged to a later time. All incisions are closed, and a cast is applied. This can be present for 2-4 weeks. After this point, rehab is initiated.
What is recovery like after an ankle replacement (arthroplasty)?
Once the surgery is complete, you are placed into a cast. The cast is required for minimum of 2-4 weeks. We will remove the sutures 2-3 weeks post op. You will have to remain non-weight bearing for minimum of 2-4 weeks. Once the cast is removed, we can start weight bearing and rehab. Often, we will transition you to a rigid removable boot, to start weight bearing. This will be weaned as you progress in physical therapy. It will likely take 3-4 months before you feel that you can walk on the ankle comfortably. The ankle replacement will continue to heal and remodel for over a year. Swelling will be present for at least 6 months. In some cases, swelling is present for over 18 months. It goes away eventually as you rehab.
What are the indications for ankle replacement (arthroplasty)?
Ankle arthroplasty, or ankle replacement, is typically considered when conservative treatments have failed, and the patient experiences persistent pain, instability, or deformity in the ankle joint. Common indications for ankle replacement (arthroplasty) include: Severe Osteoarthritis: When conservative measures such as medications, physical therapy, and joint injections are no longer effective in managing pain and functional limitations caused by advanced osteoarthritis. Rheumatoid Arthritis: In cases of rheumatoid arthritis where the immune system attacks the synovium, leading to joint inflammation, pain, and deformity. Post-Traumatic Arthritis: Following a severe ankle injury, such as fractures or dislocations, that results in long-term joint damage and arthritis. Failed Ankle Joint Replacement: In situations where a previous ankle joint replacement has not been successful, ankle revision replacement may be considered vs fusion salvage procedure. Ankle Instability: For cases of chronic ankle instability, where the ligaments supporting the joint are significantly damaged, and conservative measures are inadequate. Deformities: Ankle replacement may be recommended for individuals with deformities affecting the ankle joint, such as severe misalignment or joint malformation. The decision to undergo ankle replacement is based on a thorough evaluation by an orthopedic surgeon, considering the individual’s specific condition, symptoms, and the likelihood of success with the procedure. It’s important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the most appropriate course of action. What are the complications associated with ankle replacement (arthroplasty)? Ankle replacement surgery, also known as total ankle arthroplasty, is a procedure designed to relieve pain and restore function in the ankle joint affected by arthritis or other conditions. While it can be a successful intervention, like any surgery, ankle replacement comes with potential complications. Some of these complications include: Infection: Infection is a risk with any surgical procedure. In ankle replacement, infections can occur in the joint or surrounding tissues. Antibiotics and, in severe cases, surgical intervention may be necessary to address infections. Implant Wear and Loosening: Over time, the artificial components of the ankle replacement may experience wear, leading to potential loosening. This can cause pain and instability and may require revision surgery. Blood Clot Formation: Deep vein thrombosis (DVT) is a risk after any surgery. Blood clots can form in the veins, potentially causing complications if they travel to the lungs (pulmonary embolism). Blood thinners and compression stockings are often used to reduce this risk. Nerve Damage: Injury to nerves during surgery may result in numbness, tingling, or weakness. While nerve injuries are uncommon, they can occur and may have varying degrees of impact on sensation and function. Delayed Wound Healing: Some individuals may experience delayed wound healing or wound complications, which may require additional medical attention. Joint Instability or Malalignment: Ankle replacement aims to restore joint stability, but there can be instances of instability or malalignment, affecting the overall function of the replaced joint. Allergic Reaction to Implants: In rare cases, patients may have an allergic reaction to the materials used in the implants. Functional Limitations: While ankle replacement is designed to improve joint function, some patients may experience limitations in range of motion or functionality, especially compared to a healthy, natural ankle joint. It’s crucial for patients considering ankle replacement surgery to discuss potential risks and complications with their orthopedic surgeon. The decision to undergo surgery should be based on a thorough understanding of the benefits and risks, considering the individual’s specific condition and overall health.
How long are you non weight bearing after ankle replacement?
Typically, 2-4 weeks.
How long does it take to walk after ankle replacement?
Most patients start walking in a pneumatic boot approximately 2-4 weeks post op.
Will I limp after ankle replacement?
Your gait after an ankle replacement will be different, compared to pre op, or someone without arthritis. However, it is important to keep in mind, that most patients who undergo ankle replacement have severe ankle arthritis. They have stiffness in the ankle, and tend to walk with an alter gait / limp pre op. The goal of surgery is to try and eliminate this limp, however some patients may have a residual limp post op. Compared to an ankle fusion, ankle replacements have more normal gait, and less perceived limp.
Are total ankle replacements successful?
Ankle replacements boast a patient satisfaction rate of 80-90%. This is when it is done in an appropriate patient with the correct indications. Speak to one of our experts to see if you are a good candidate for replacement surgery.
How long does pain last after ankle replacement?
The pain of surgery is worst in the first few days. After this pain slowly improves. Most patients have little pain by 6 weeks. Swelling is typically the biggest hurdle and may exacerbate pain as you increase your activity. However, this settles over several months.
How limited is ankle movement after an ankle replacement?
When we replace the ankle joint, you lose some motion at that joint. However, our goal is to preserve as much motion as possible. Typically, motion that you have pre-op is maintained. Certainly, more motion is maintained as compared to an ankle fusion procedure.
How long does an ankle replacement take to heal?
The incision is well closed around 2-3 weeks post op. The bones/implants need approximately 6-8 weeks to in-grow. However, the bones will continue to remodel / heal for over a year. Patient factors can affect this healing time. Delays in healing time are seen in patients that have diabetes, smoke, are non-compliant with post op orders, have peripheral vascular disease, etc.
Does replacement of ankle include tenolysis? Is tenolysis of ankle included with ankle replacement?
Often when we perform an ankle replacement, we will mobilize tendons as a part of our approach. This allows us to safely move them out of the surgical field, so that they are at less risk of damage. In doing so, we also have a chance to remove adhesions within the tendon sheath, which is common in arthritis.
Is ankle replacement a disability?
Ankle replacement is a surgical procedure aimed at treated patients with ankle pathology. Typically, patients have disability pre-op due to pain/stiffness/instability/ and deformity. However, the goal is to eliminate this disability post operatively.
Is ankle replacement a major surgery?
Yes. Ankle replacement is a major surgery. It is associated with serious complications. The decision should not be taken lightly. Please discuss this further with our experts if you think you are a candidate for this surgery.
Can you run after ankle replacement?
Some patients are able to get back to running after an ankle replacement. However, it is designed more so, for low impact activity. As a result, some patients may no tolerate running after an ankle replacement.
Can ankle fusion be reversed?
No. However, in some rare instances, we can take down an ankle fusion and do an ankle replacement.
Can you have an ankle replacement after a fusion?
Yes. In some rare instances, we can take down an ankle fusion and do an ankle replacement. Talk to one of our experts if you think you are a candidate for this procedure.
Can you have ankle fusion after ankle replacement?
Yes. This is done often done when an ankle replacement wears down beyond revision replacement.
Can I drive after ankle replacement? How long after ankle replacement can I drive?
Yes. Once you have recovered and rehabbed enough to safely operate the pedal, you can drive. Typically, this is 6-8 weeks after surgery. However, you should always confirm with your doctor prior to taking this risk.
Can I walk normally after ankle replacement?
In order to eliminate ankle pain, we need to replacement the ankle joint. Patients will typically notice stark improvement of pain, at the cost of flexibility. The ankle is stiff before and after surgery. This means that you can typically walk, without pain. However, your gait may be slightly different. Some patients have a limp in the post operative period, but this resolves with time. Certainly, much more motion is maintained at the ankle joint, as compared to an ankle fusion surgery.
Can you wear heels after ankle replacement?
Typically, no. Some patients are able to do this. Most are not able to get back to wearing long heels.
Can you wear normal shoes after ankle replacement?
Yes
Do you have to wear special shoes after ankle replacement?
Typically, no. However, you may benefit from custom shoes if you have an underlying foot deformity.
How long do ankle replacement last?
Modern implants are showing much longer survival compared to older implants. Most patient will get 15-20+ years out of replacement surgery. 90% of patients are happy and functional at 10 years post op.
How long does an ankle replacement operation take?
Approximately 3-4h. Possibly longer if we also have to repair ligaments / correct deformity.
How much does an ankle replacement cost?
Most of the cost related to ankle replacement is covered by your insurance. Your out-of-pocket cost depends on your individual insurance plan. Speak to a member of our billing team to figure out details related to anticipated out-of-pocket expenses.
Can an ankle replacement result in plantar fasciitis?
Some patients can experience plantar fasciitis in the post operative period. This is usually in patients with an element of plantar fasciitis prior to surgery. It tends to be exacerbated by casts and pneumatic boots.
Can I dance after ankle replacement?
Yes
Can I go upstairs after ankle replacement?
Yes
Can I hike with ankle replacement?
Yes
Can I work construction after an ankle replacement?
Typically, yes. There may be other foot conditions that limit your ability to perform hard manual labor after this type of surgery. But in isolation, after rehab, you should be able to return to construction.
Can they do ankle replacement on both feet? Can I get bilateral ankle replacement at the same time?
This is not recommended. We will usually recommend that you have one side at a time. This will allow you to rehab using the non-operative leg. Initially, you cannot put weight on the operative side; thus, you need a leg to stand on. Otherwise, you will have very limited mobility for a few months. Furthermore, bilateral surgery increases the risk of blood clots, falls, secondary trauma, etc.
Can you ice skate after recovering from an ankle replacement?
Yes. Although, many people have problems getting into skates. We recommend back or front- loading ice skates (similar to ski boots) for skating.
Can you squat after an ankle replacement?
Yes
Can you ride a bike after ankle replacement?
Yes. In fact, it is encouraged.
Do they scrap out arthritis in ankle replacement?
Yes. We removed residual cartilage, cartilage flaps, hard subchondral bone, and loose debris.
Do you need physical therapy after ankle replacement?
Vast majority of the time, yes.
Do bone stimulators work for ankle replacements?
There is a theoretical advantage to using a bone stimulator after replacement surgery. However, most clinical studies do not show an advantage in the real world. We typically will utilize this modality if healing is slow or delayed.
Do you need prescription rocker bottom shoes for ankle arthritis?
You can get a prescription, but there are over the counter options as well.
Does ankle replacement affect driving?
Most patients are still able to drive. Arthritis causes less ankle flexion/extension. As a result, most people use more of their leg muscle to accelerate and brake. However, ankle replacement maintains ankle motion, compared to an ankle fusion. Thus, you will drive more normally with a replacement, as opposed to a fusion surgery. Regardless, some re-training will be required.
Does ankle replacement limit mobility?
Most patient will have improved mobility, as they no longer are limited by debilitating ankle pain.
Does ankle replacement take all the pain away?
This is the goal. Most patients have complete resolution of pain at the ankle. However, there is a risk of residual pain with this surgery. Majority of these patients (with residual pain), the pain they experience is vastly better than their arthritic pain.
Can ankle replacement be done as out patient surgery?
In some cases. Since this is a larger procedure, we will typically do it at a hospital. There is a good chance you may go home the same day. However, it is not atypical for patients to stay one night.
