Joel D. Stewart, MD
Ankle Replacement surgery has been around for decades, but until recently, it had a very unpredictable success rate. Advancements in the implant materials (prostheses), different design rationales and surgical techniques have now made ankle replacement a viable treatment option for those who have severe arthritis of the ankle joint due to age, genetics, disease or injury. As a fellowship-trained orthopaedic foot and ankle surgeon, I want to provide you with the information you’ll need to make the best decision about treatment for your severe ankle pain.
Here are the conservative treatments I prescribe first for my patients, before proceeding with surgical procedures:
- Over the counter NSAIDs (like naproxen sodium or ibuprofen)
- Prescription anti-inflammatory medications (topical and by mouth)
- Physical Therapy
- Splinting or custom bracing
- Intermittent steroid injections or other into the joint
If all of these don’t give you enough relief on your ankle arthritis, I sometimes recommend other surgical procedures, which are often done to “buy time” before ankle replacement. Arthroscopic “ankle scope” debridement of the ankle joint can clean out bone spurs, torn cartilage and smooth rough bony areas. If there is a great deal of angulation of the ankle or foot, then these may be straightened. This can be performed by breaking bones or moving tendons or ligaments.
If the treatment options given above fail and my patient continues to suffer considerable pain and limitation, we discuss arthrodesis (ankle joint fusion) or arthroplasty (ankle joint replacement). While there are pros and cons to each option which I discuss thoroughly with my patients, in this article, I’ll focus on ankle replacement.
Planning for an ankle replacement surgery takes some time and thought. You’ll be on crutches or a knee scooter for 4-6 weeks, non-weight bearing. Plan on having someone with you for the first few days after being released from the hospital, at a minimum. You’ll need someone to drive you to follow-up appointments (especially if you are still on medications or if it is your right ankle). You’ll also need to prepare your home to have easy access to the restroom and kitchen before surgery and to remove any slip hazards, such as throw rugs and mats. Depending on the type of job you have, you will need to make arrangements to take time off for your recovery.
Before surgery, we’ll need to make sure that you are healthy and get any pre-operative clearances necessary, if other physicians are managing any pre-existing conditions such as high blood pressure or diabetes. If you smoke, you should quit. Some medications need to be altered or stopped before a surgery.
The time it takes for an ankle replacement surgery to be performed can vary, depending upon the surgical approach used, the type of implant and any additional procedures that must be corrected (ligament tightening, achilles lengthening). You can expect to be in surgery anywhere from 2-4+ hours. You’ll be under anesthesia, often we use a nerve block, and you may also need to be placed on a ventilator so your breathing can be safely controlled during the procedure.
Fit and healthy patients may be able to have their surgery on an outpatient or same-day basis. Most of my patients spend one night in the hospital, so that they can receive IV antibiotics, pain medication and therapy. Because ankle replacement is a major surgery, you can expect some post-operative discomfort, which will lessen in the days after the surgery.
Recovery from an ankle replacement surgery occurs in three phases and usually takes anywhere from six months to a year – Here’s what to expect:
- Phase I – 4-6 weeks totally non-weight bearing, at home ROM exercises and minimal Physical Therapy, may work from home at a sedentary job
- Phase II – 4-6 weeks progress to full weight-bearing, moderate Physical Therapy, may return to work at a sedentary job
- Phase III – Weight-bearing, with intensive Physical Therapy, may return to full duty work depending on recovery and type of job, but you may still be in a brace for some time
Activities you can enjoy once you’ve recovered from ankle replacement are moderate types of exercise, such as biking, walking and swimming. Activities that put undue stress on your newly replaced ankle, such as running or sports that include jumping, are greatly discouraged.
Make an appointment with Dr. Stewart or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.