Total ankle replacement (TAR) is recommended for severe ankle pain which has not responded to conservative treatment: weight loss, activity modification, physical therapy, and anti-inflammatory medication and cortisone injections. Severe ankle pain can result from the following:
Ankle pain can manifest in the shin, ankle, and shin. It usually increases with activity and alleviates with rest. It may occur at night and prevent sleep. This pain is associated with stiffness, limping and functional limitation which significantly affects quality of life.
A TAR is the surgical implantation of an artificial ankle (prosthesis). The worn out joint surfaces of the end of the shin bone (tibia) and the top of the ankle bone (talus) are removed. Extreme care using precise instruments are used to insure a level surface for the implant. A metal and plastic implant is inserted into the prepared bone ends to create a new joint surface. Because the artificial ankle joint has smooth surfaces, like cartilage, complete, or near complete, pain relief is experienced which allows improved motion, enhanced function and less limping.
Ankle replacements have become better designed and more successful. A good candidate is older, less active with an average body weight. Therefore, a poor candidate is young (under 50 years old), active and overweight. For this group with disability and chronic pain an ankle fusion surgery may be more appropriate than a joint replacement.
Predicting the longevity of a TAR on an individual basis is impossible. According to Guido LaPorta, DPM, ankle implants of the 1970’s were not good and resulted in poor outcomes. Those of the 1990’s were good but not great. However, there is an 82 to 90% chance that new TAR’s will last 10-12 years in the appropriate patient.
Recovery following TAR takes 12 weeks. The ankle may be warm/swollen for 3 to 6 months (ice and elevation will help). The ankle will show improvements in function for up to a year. Overall a TAR relieves pain and stiffness, improves mobility and restores quality of life! Instead of limping in pain, you will return to walking painfree and maybe playing golf!
Contributor: Guido LaPorta, DPM, is president of LaPorta and Associates, a podiatric group with several offices in Northeast PA. He is also director of the podiatry residency program at Community Medical Center in Scranton, PA.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.