Total Ankle Replacement

What is a Total Ankle Replacement?

A Total Ankle Replacement (TAR) is an artificial joint used to replace an arthritic or diseased ankle joint. You may not be aware of them as they are much less common than hip or knee replacements, but are very similar in nature and outcomes. Metal parts replace the damaged bone  surfaces and a special plastic spacer allows the joint to move.

What does a Total Ankle Replacement entail?

A Total Ankle Replacement is a big operation. It usually takes about 90 minutes.

It can usually be done as a day case or with a 1 night hospital stay. It involves an incision (cut) at the front of the ankle. Through this a saw is used to cut the end of the tibia and the top of the talus to remove the diseased bone surfaces. Metal parts are then hammered into the cut ends and a plastic spacer inserted between these.

The metal and plastic components are shaped to allow the joint to move. X-rays are taken throughout the operation to allow them to be precisely positioned. After the operation the ankle is placed in a plaster for two weeks.

You would then attend the clinic for a post operative consultation to check how the wound is healing.

At this point you would start physiotherapy and allow you to mobilise walking on the new joint.

Not every one can have an ankle replacement, some people are too young, too old or have a pattern of arthritis which makes the surgery impossible, usually a big deformity. These factors would be discussed in detail and the alternatives balanced against the risks, to allow informed choice.

Objectives of a Total Ankle Replacement

Nearly all ankle replacements are done for pain relief. It is a very good treatment of painful arthritis. A Total Ankle Replacement also allows some movement in the ankle joint allowing a more natural walking pattern after the surgery. Some deformity can be corrected with an ankle replacement.

What are the risks

• 1% risk of infection, lower for deep infection, but this can be very serious requiring more surgery.
• 5% will fail in the first ten years, some of these could be much sooner
• Fractures can happen around the joint replacement - these can be more complex to fix than a native ankle
• DVT/PE blood clots can occur after a Total Ankle Replacement, whilst this is less common than hip and knee surgery, you will be given medicine to thin the blood and reduce this risk further.

How successful are they

After a Total Ankle Replacement patients usually report their pain reduces to 1 or 2 out of ten. Walking distances improve and 95% of replacements last ten years or more.

What is the recovery timeline?

We would expect a return to driving and increased walking by 6 weeks post operation, work between 6 and 12 weeks depending on your job. Full recovery can take a whole year (swelling, stiffness).

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