Mr Tristan Barton, Consultant Orthopaedic Surgeon and Foot and Ankle Specialist at Circle Bath, tells us how ankle replacement surgery is performed, and why you might need it…
Osteoarthritis can occur as a result of general wear and tear of the cartilage in your joints. This is often a consequence of a previous ankle injury. Cartilage covers the ankle joint like a carpet, and protects the joint as you move. When this cartilage starts to wear out, it can result in pain and stiffness. If osteoarthritis develops within your ankle, you may notice some swelling around the joint, and it may become increasingly difficult to walk. If a patient comes to see me with these symptoms, I have two main priorities:
- Address your pain
- Improve your quality of life by enabling you to be more mobile and helping you to regain function.
There are various treatments available, and I tend to start off non-operatively. We will initially discuss your ankle and the effect this is having on your mobility. This will be followed by an examination of your ankle and obtaining further x-rays of your ankle if needed. These x-rays will confirm and indicate the severity of any osteoarthritis in your ankle. With a confirmed diagnosis, we can then discuss all the treatment options available to you.
If your osteoarthritis is advanced and hasn’t responded to non-operative treatments, the best option may be a form of surgery. The two main surgical options available to you are an ankle fusion or ankle replacement. Both of these options will reduce the pain from your ankle. A fusion will result in a stiff ankle, whilst a replacement will maintain some ankle movement. Both operations have a high success rate, and there are pros and cons to each procedure. I will discuss each procedure with you, so that we can find the best solution that is tailored to your needs and expectations.
An ankle replacement will aim to reduce the pain from your ankle joint, and improve your mobility by maintaining ankle movement. Like any joint replacement, ankle replacement surgery is a major operation. It is an alternative to an ankle fusion (which stiffens the ankle joint), and has been gaining in popularity all over the world as the implants and surgical techniques have improved.
This operation usually lasts around 2 hours, and you will typically have a general anaesthetic, so will be asleep for the procedure. Other anaesthetic options are available to you.
I start off by making a 15cm vertical incision down the front of your ankle. I then remove the arthritic ankle joint bones and worn cartilage, which creates space for the new ankle joint. The metal components that make up the new joint are then put in place, with a plastic insert placed in between them that allows for movement of the ankle. The incision is closed with stitches, and I then apply a below-knee plaster cast to support the joint while it heals.
You will most likely need to stay in the hospital for 1 or 2 days following surgery, and our physiotherapy team will be on hand to help you mobilise, walking with either a frame or crutches. You will not be able to put any weight through the plaster cast for 2 weeks.
Rest is vital in the early stages of recovery, and it is a good idea to keep your foot elevated as much as possible, especially in the first 2 weeks. I will see you for a follow-up appointment after 2 weeks, at which point I should be able to remove the cast and swap you to a removable walking boot.
Our physiotherapy team will have given you some basic exercises to try once your ankle is capable of moving, and will let you know when you can begin to place weight on the ankle. After 6 weeks, you will have another x-ray, which will allow me to check on the progress of your recovery.
You can usually start driving again after 12 weeks (unless you have an automatic car and the operation was on your left foot, in which case there is no need to wait). In terms of a full recovery, the typical time frame is between 6 and 12 months to allow all the swelling and stiffness to subside.
As with any surgical procedure, there are certain risks to be aware of. Your ankle will feel stiff after the operation, but this will improve over time. Physiotherapy during your recovery will also address the stiffness and gradually help improve your flexibility and range of motion.
Issues can arise around your scars, particularly just after the operation, where there may be some residual numbness. Later on, your scars may feel sensitive, and massaging the scar will help this.
There is also the chance that even after surgery, your symptoms could persist. I would hope that your symptoms are much improved, but in a minority of patients there may be on-going symptoms.
Problems can also arise with the replacement itself. With any joint replacement, there is a very small risk of infection that requires further surgery. There is also a risk that over time, the replacement can loosen or become painful. If this progresses, revision surgery may be needed. Such surgery can take the form of another replacement or a fusion.
At Circle, we have a dedicated foot and ankle unit, ensuring an unparalleled level of care, personalised for your needs.
Ankle replacement surgery is a complex procedure that should only be carried out by experienced surgeons with expertise in this field, and this is exactly what we offer at Circle. If you suspect you have arthritis in your ankle, causing your mobility to deteriorate, why not book a consultation to discuss your treatment options with us? With no waiting lists, our multi-disciplinary team can work out the best treatment plan for your specific needs, helping to restore your quality of life.
- Ankle arthroscopy
- Ankle ligament repair
- Ankle replacement surgery
- Big toe cheilectomy
- Toe deformity correction
- Foot bunion removal surgery
- Ganglion removal (feet)
- Repair of tibialis posterior tendon
- Ankle fusion
- Subtalar fusion
- Triple fusion
- Midfoot fusions
- Rheumatoid foot reconstruction
- Ingrowing toenail treatment
- Bone spurs