What is a Total Ankle Replacement?
This is an operation designed to replace the worn out, arthritic ankle joint with a prosthesis which aims to preserve movement and get rid of the pain. It involves a skin incision over the front of the ankle to gain access to the joint. The worn out cartilage at the bottom end of the tibia (shin bone) and the dome of the talus (ankle bone) is removed and replaced with a metal prosthesis with a specialised high strength plastic tray in between.
Will my ankle movements improve after having an ankle replacement?
The aim of this operation is not to ‘improve’ but to ‘maintain’ the amount of movement you already possess. The key being that the movement maintained will be sufficient to perform all activities without discomfort.
Type of procedure
This is an inpatient procedure and you will most likely be discharged in two to three days time.
Type of Anaesthesia?
The operation will be undertaken under a general anaesthetic supplemented with an injection regional nerve block. The effect of this block will last for a few hours after surgery.
How long will the surgery take?
The surgery normally takes about 2 to 2 1/2 hours.
General Recovery Facts
Exercise and sporting activity after your total ankle replacement
For many individuals, a return to an active lifestyle is our goal following this surgery. For some, this may mean the ability to walk without pain, and for others, a more regular exercise routine may be more important. Regular exercise in a gym is always to be encouraged, and the use of all machines including bicycle, stair climber, and elliptical machines are excellent to regain strength and movement of the ankle. It is never recommended that you run. You may however engage in golf, prolonged hiking or walking, doubles tennis and bicycling, and under certain circumstances, skiing. An orthotic arch support is important for your recovery and this will be provided to you by our orthotist.
Specific post-operative recovery :
Risks of surgery:
Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.
This is a fairly routine procedure withrisk of:
If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is rare, but if this does occur it will require the ankle prosthesis to be removed and antibiotic cover for about 6 weeks prior to considering a revision or a fusion operation. Overall risk is 1%.
Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar or the top of the foot. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.
Clots - Deep vein thrombosis
Extremely rare in foot and ankle surgery (<5%). However you will be given blood thinning injections after surgery for 4 weeks to minimise this risk.
This can occur and will manifest as ongoing pain or swelling. X-rays and a CT scan will be required to diagnose the area of loosening.
Recovery from surgery
When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot and a below knee back slab (which is half a plaster) applied. You will not be allowed to walk on the operated foot for atleast 6 weeks. The physiotherapists will make sure that you are safe on your feet before discharge and you will be provided crutches. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.
2 weeks after surgery - wound check and advice regarding basic hygiene
6 weeks after surgery - X-rays and advice regarding exercise
3 months after surgery - clinical exam and Xray
6 months - clinical exam and Xray
Annual check there after.
You are not allowed to put weight on the operated leg for atleast 6 to 8 weeks.However you will be allowed to mobilise with crutches
How do I look after my surgical wound site?
Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.
Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.
When can I get back to driving?
It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is 6 weeks after surgery.
Click here to read the guidance from the DVLA on driving after surgery