Total Ankle Replacement

Ankle replacement surgery (TAR) is used to treat an ankle that has end stage arthritis, either rheumatoid, osteo or post traumatic arthritis.  The diseased joint is surgically excised and replaced with two metal components with a high density plastic insert in between.

The main benefit of this surgery is pain relief. Excising the diseased joint removes the source of pain from the ankle but occasionally some discomfort may persist.  This may be from the surgery itself or from neighbouring joints which may also be affected by some degree of arthritis.

Movement of the ankle after surgery is not expected to be normal as the joint will not have moved properly for some time because of the underlying disease.  However it is expected to allow enough movement to walk well.  Light exercise such as cycling and swimming are also reasonable expectations.

Ankle replacements have been used for some years but are not as successful as replacements of the hip and  knee.  Modern designs however can be expected to survive for over 10 years before failing.  Approximately 90% of ankle replacements will last more than 10 years and some will last for much longer.  However 10% will fail before 10 years for various reasons and may need to be revised to a new replacement or may need to be removed and the ankle then fused together.

The main complications that can occur are listed on the general information page.  Infection is one of the most serious problems and occurs in approximately 1% of cases.  If an implant becomes infected the body is unable to erradicate the bacteria and the joint replacement will probably need to be removed.  The joint may be replaced after an interval of 6-12 weeks or it may need to be fused together (stiffened).

The components of the TAR are inserted without bone cement.  The bone is cut accurately using jigs to ensure a very tight fit between the implant and the bone.  New bone will form and grow onto the surface of the metal which has been treated to encourage new bone growth.  This ensures a secure interface which should then last.  The two metal components are separated by a smooth high density plastic which allows movement between them.  This is designed to minimise friction which should help the TAR to last longer.

It is not always possible to perform this operation because the bone may not be strong enough or there may be excessive deformity at the ankle because of the disease process. In these situations you will be advised to have the ankle fused (arthrodesis).  This is because ankle replacements do not last as long in the presence of deformity.