Total Ankle Replacement

Total Ankle replacement or Total Ankle Arthroplasty is the technique of removing the ankle joint and inserting a prosthetic metal and polyethylene joint. In recent years this has advanced with improved techniques and prosthesis to provide results that make it an effective option for the suitable patient. In my practice this involves Patient Specific Jigs based on CT scan customised plans.

Ankle Replacements are effective at pain relief, and preserve the range of motion of the ankle joint. As a result, it reduces the subsequent stresses upon the adjacent joints in the foot and the knee and decreases the risk of developing arthritis in those joints compared to fusion.

Ankle replacement results in a more natural gait pattern and walking pattern on inclines and stairs and as a result research has shown high satisfaction rates in outcome scores. It is well studied in the Australian Joint Registry which monitors all total ankles put in in Australia.

In general 85% of patient’s prosthesis are successful at the 10 year mark. Using data from previous prostheses, Patients over 65 have a 13% risk of failure after 10 years, and patients aged 55-65 up to 18%. Ankle replacement is suited to patients ideally over 65 with range of motion of the ankle and particularly for patients with arthritis in the surrounding joints.

Surgery

Before surgery a CT scan is performed to prepare the customised Patient Specific Jigs.  An engineered plan is then used to create the ideal mechanical alignment, and specific anatomical details are incorporated. The jigs are made and sent to the hospital. This process takes 6 weeks.

At Surgery an incision is made on the front of the ankle, and the specialised jigs are fitted to allow the bone cuts to be made. The Prosthetic trials are fitted, and then balancing of the joint and ligaments is performed.  This is important for a stable joint with good range. Occasionally to balance a joint properly other procedures around the foot and heel are required. X-rays are taken during the case to confirm alignement.

The Definitive Implants are then inserted. The ankle is placed in a plaster back-slab following surgery. 

The post operative course is 2 weeks elevation, then 4 weeks of walking in a boot and range of motion exercises, before commencing a graded return to activities. Full recovery can take up to 6 months.

Total Ankle Replacement

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