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Ankle Replacement: A Comprehensive Guide

The ankle joint plays a critical role in everyday movement, from walking to running and maintaining balance. When severe arthritis or injury damages this joint, it can lead to chronic pain, stiffness, and reduced mobility.

For some patients, an ankle replacement may provide a solution to restore function and quality of life.

This blog explores the anatomy of the ankle, and what you need to know about ankle replacement surgery.

Anatomy of the Ankle

The ankle is a complex hinge joint formed by three primary bones:

  1. Tibia: The shinbone, which forms the inner part of the ankle.
  2. Fibula: The smaller bone of the lower leg, which forms the outer part of the ankle.
  3. Talus: A small bone that sits between the tibia and fibula above and the heel bone (calcaneus) below.

These bones are connected by ligaments that provide stability, while tendons facilitate movement.

The joint surface is covered with cartilage, a smooth tissue that allows for pain-free movement.

This intricate structure supports weight-bearing and enables flexion, extension, and slight rotational movements.

What Is an Ankle Replacement?

An ankle replacement, also known as total ankle arthroplasty, is a surgical procedure in which a damaged ankle joint is replaced with an artificial implant. This surgery aims to alleviate pain, improve mobility, and restore a functional range of motion.

The procedure involves removing the damaged portions of the tibia, fibula, and talus and replacing them with a prosthetic device designed to mimic the natural joint's anatomy and function.

Who Needs an Ankle Replacement?

Ankle replacement is typically recommended for individuals with:

  • Severe ankle osteoarthritis that significantly impacts daily activities.
  • Post-traumatic arthritis, resulting from a previous injury.
  • Rheumatoid arthritis, which causes joint inflammation and destruction.
  • Failed previous surgeries, such as unsuccessful ankle fusions or other interventions.

Ideal candidates are individuals who:

  • Have relatively stable ligaments.
  • Are not significantly overweight, as excess weight can strain the implant.
  • Are older or less active, as high-impact activities can shorten the lifespan of the prosthetic device.

Who Is Not a Good Candidate for Ankle Replacement?

Ankle replacement may not be suitable for individuals with:

  • Severe deformities or instability of the ankle.
  • Advanced osteoporosis, which weakens the bones.
  • Ongoing infections in or around the joint.
  • A history of high-impact activities or jobs that require heavy manual labour.
  • Neuropathy or loss of sensation in the foot and ankle.

In these cases, alternative treatments, such as ankle fusion, may be more appropriate. I always ensure that my patients are kept informed of all their options and risks so that they can make an informed decision.

What Is the Best Ankle Replacement Device?

There is no single "best" ankle replacement device, but the Prophecy Total Ankle Replacement (TAR) from Stryker has proven to be the best replacement I have used so far.  

This device includes some very helpful features, the most notable being the resection guides manufactured according to pre-operative standing CT scans – these scans include the foot, ankle and knee which gives highly accurate information of the whole of the lower limb.

This customisation makes the operation more predictable, accurate, and significantly reduces operating time, leading to better outcomes for patients.

Over the last 20 years I have used other ankle joint replacements like the  Hintegra Total Ankle Replacement TAR, the Mobility TAR and the Zenith TAR and there are other implants like the STAR ( Scandinavian TAR) and the Zimmer Trabecular Metal TAR on the market but due to the patient specific instruments and the most modern design the Prophecy TAR seems to be the best implant available. 

Components of an Ankle Replacement Device

An ankle replacement device typically consists of three main components:

  1. Tibial Component: Replaces the lower end of the tibia.
  2. Talus Component: Replaces the upper surface of the talus.
  3. Polyethylene Spacer: A durable plastic insert that sits between the tibial and talus components, facilitating smooth movement and absorbing stress.

These components are usually made from biocompatible materials such as titanium, cobalt-chromium alloys, and polyethylene to ensure longevity and compatibility with the body.

The Process

  1. Surgery: The procedure is performed under general or regional anaesthesia. The damaged joint surfaces are removed, and the prosthetic components are installed.
  2. Postoperative Care: After surgery, your ankle will be placed in a splint or boot for 10-14 days to protect the ankle joint and allow initial healing.
  3. Hospital Stay: Most patients stay in the hospital for 1-2 days, depending on their recovery and pain levels.
  4. Weight-Bearing: Initially, you will use crutches or a walker to avoid putting weight on the operated ankle. Gradual weight-bearing begins normally 2 weeks after the operation and you will be allowed to gradually increase your weight bearing over a period of 2 to 4 weeks so that you are able to fully weight bearing about 4 to 6 weeks after the operation.
  5. Physiotherapy: Rehabilitation exercises are crucial to restore strength, flexibility, and mobility. You should see an experienced physiotherapist as soon as you are allowed to start putting some weight through the operated leg (after 2 weeks) and you will learn how to walk partial weight bearing and work on the flexibility of your ankle joint replacement. It is important that you exercise and mobilise your ankle daily in order to achieve the best outcome.

How Long Will I Need to Be in the Hospital?

Following an ankle replacement, most patients stay in the hospital for 1-2 nights. During this time, your medical team will monitor your recovery, manage pain, and ensure there are no complications.

You’ll also receive instructions on caring for your surgical site and using assistive devices like crutches.

How Long After Surgery Can You Walk?

Most patients begin walking with the aid of crutches or a walker within 2-4 weeks post-surgery. However, full weight-bearing on the ankle may take 6-8 weeks, depending on individual healing.

I ensure that my patients are monitored closely over this period by an experienced physiotherapist, to ensure optimal recovery.

What Is the Recovery Time Following an Ankle Replacement?

Recovery time varies but typically follows this timeline:

  • Weeks 1-2: Rest, elevation, and limited mobility with a splint or boot.
  • Weeks 3-6: Gradual weight-bearing and the introduction of physiotherapy.
  • Weeks 6-12: Start walking unaided and increase level of activities, continue physiotherapy.
  • Months 3-6: Continued strengthening and mobility exercises; most patients return to normal daily activities.
  • 1 Year: Full recovery, including improvements in pain relief and joint function.

What Are My Limitations Following an Ankle Replacement?

While ankle replacement can significantly improve quality of life, certain limitations should be expected:

  • Avoid high-impact activities like running, jumping, or heavy lifting.
  • Be cautious with activities that involve uneven terrain to prevent falls.
  • Returning to sports and recreational activities; low-impact options like swimming or cycling are usually recommended.

Will I Need Rehab After My Ankle Replacement?

Yes, rehabilitation is a vital component of recovery. A physiotherapist will guide you through exercises to:

  • Restore strength and flexibility.
  • Improve balance and stability.
  • Teach proper walking techniques to avoid strain on the new joint.

Rehabilitation typically lasts 3-6 months but may continue longer depending on your progress.

Conclusion

Ankle replacement is a sophisticated and highly specialised surgical procedure that offers significant pain relief and improved mobility for those suffering from severe ankle arthritis or other debilitating conditions.

Over the last 20 years the outcome of these procedures has improved considerably and being able to use custom made resection guides has made a huge difference to these operations resulting in much higher patient satisfaction rates. 

By understanding the process, recovery timeline, and potential limitations, patients can make informed decisions and set realistic expectations for their outcomes.

If you are suffering from ankle pain that could be caused by arthritis of the joint and you think that you might benefit from this treatment or if you have questions about your suitability for the procedure, schedule a consultation with me to discuss your options and develop a personalised treatment plan.

I will listen to your concerns, take a full history, examine your ankle and foot and if needed get some imaging to provide you with all the information necessary so that you make an informed decision of what will be the best treatment for you personally. 

About Martin Klinke

Top Ankle Surgeon in London

Martin Klinke is one of the leading ankle surgeons in London. With an impressive background in both Orthopaedics and Sports Medicine, he takes a comprehensive and compassionate approach to your treatment. He’s a trusted, reputable surgeon who can help get you back in the game!

Mr Martin Klinke offers outpatient consultations at HCA at the Shard, Chiswick Outpatient & Diagnostic Centre, HCA Canary Wharf, BUPA Cromwell Hospital and the New Victoria Hospital. He operates from London Bridge Hospital, BUPA Cromwell, and New Victoria Hospital and the Hospital of St John and St Elizabeth.

You can find all his patient reviews here.

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