About this service
An ankle replacement (arthroplasty) is the replacement of a damaged or arthritic ankle joint with an implant (prosthesis).
If a patient has mild or moderate arthritis their surgeon may recommend non-surgical treatments such as pain control; steroid injections; orthotics or physiotherapy.
For patients who have severe arthritis or injured their ankle, a surgeon may recommend an ankle replacement. An artificial ankle joint (prosthesis) is implanted to replace the damaged cartilage. The surgeon will select the type of implant that best suits a patient's needs.
A number of patients may be invited to attend a pre-operative assessment clinic one month before the operation. During this visit they will be asked about their medical history and any medications they are taking. Blood tests will be carried out and patients may have an electrocardiogram (ECG) and x-ray.
A consultant anaesthetist will discuss the options for anaesthesia, as well as the risks and benefits associated with each. Pain management plays an important part in recovery and rehabilitation and is often of great concern for patients. The consultant anaesthetist and nurse at the clinic will talk to patients about pain management after surgery.
The pre-operative assessment clinic gives patients the opportunity to see the physiotherapist and nurse, ask any questions they may have and plan for their discharge from hospital.
It is important for patients to be in the best possible overall health prior to surgery.
Patients and their healthcare team can take several actions before and after surgery to reduce the risks of complications.
- Medication: patients should inform their surgeon of what medication they are on. The surgeon will review and decide if any of these need to be stopped before the procedure.
- Diet: in the weeks before surgery eat a balanced diet as this can help the healing process.
- Smoking: to reduce the risk of infection patients who smoke will be asked to stop smoking for 1 month before and after the operation.
- Blood clots: to reduce the risk of developing a blood clot in the legs or lungs, a number of recommendations will be given to the patient in advance of surgery.
- Infection: for patients who have signs or symptoms of an infection, such as a chest or urinary infection in the days prior to surgery, the surgeon should be informed. The surgeon will also need to be advised of a rash or flare up of psoriasis or eczema around the hip area or a leg ulcer. For patients who have a history of MRSA/VRE or have been In contact with someone with MRSA/VRE, the healthcare team should be informed.
- Exercise: it is important to be as fit as possible before the procedure, as it will make recovery much faster. Patients will be given a personal exercise programme to follow in advance of and for a time after the procedure.
During the procedure the surgeon will make an incision to the front or side of the ankle depending on the type of implant to be used. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The implant components will then be inserted to recreate the ankle joint. The wounds will then be closed by the surgeon and a splint applied. The procedure takes approximately two and a half hours. A period of non-weight bearing in either a cast or cast boot is necessary to allow the implants to heal in place. The surgeon will also assess if the calf muscle or Achilles is tight and may complete an additional lengthening procedure of the Achilles tendon if required.
- After surgery, you will stay in the recovery room for one to two hours before being discharged home.
- You will need someone to drive you home and stay with you for atleast the first night.
- Patients will stay in the hospital approximately two to three days.
- It is to be expected that there will be some pain and discomfort after surgery. Patients will be given pain medication in hospital and will be sent home with a prescription for pain medication.
- Patients should organise for someone to drive them home from the hospital and stay with them for at least the first night.
- After their surgery, patients will not be able to weight bear on the ankle for a period of time to allow the implants to heal and may be fitted with either a cast or cast boot. Patients will need to use crutches for several weeks. Your surgeon will provide instructions about your recovery and rehabilitation.
- Patients will be given an appointment to attend the dressing clinic two weeks after surgery.
- Patients will be given an appointment to attend their surgeon four to six weeks post-op.
- Patients will require a follow-up x-ray four to six weeks after surgery.