Ankles are hard at work supporting your weight and making it possible for your to use your feet. Standing, walking, running, jumping, and even sitting up in a chair all rely on your ankles to support your legs and body. For patients with ankle arthritis, pain is just a part of daily life. But when persistent ankle arthritis from a chronic ankle injury or ankle fracture makes walking, exercising, or climbing stairs unbearable, it’s time to consider your treatment options. Ankle replacement is often the treatment of choice for people who want to continue their active lifestyles, and the orthopedic specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, will work with you to get the help you need to alleviate your pain and preserve motion at the joint so you can get going with your life.
Ankle replacement surgery is the replacement of a damaged ankle joint with an artificial implant. Patients who undergo ankle replacement are typically in their 40s through 60s, although older individuals who are “physiologically young” may also be good candidates. The best candidate is a healthy person with ankle arthritis who has minimal or no deformity of the ankle. In general, an ankle replacement will function best in patients who have somewhat less-active lifestyles. High-impact activities such as running and jumping can damage an ankle replacement. It is also best for people who are not overweight. Recently published literature shows long-term survivorship for a replacement to be as high as 93%, which is significantly higher than previous generations making it a much more viable option to treat painful ankle pain.
THE ANKLE JOINT AND ARTHRITIS
The ankle joint (tibiotalar joint) is where the shinbone (tibia) rests on top of a bone of the foot (talus). There is cartilage throughout the ankle that cushions the joint. In severe ankle arthritis, the cartilage is worn down to the point that there is bone-on-bone grinding or contact with the joint. The three types of ankle arthritis are:
- Osteoarthritis-this is “wear and tear” arthritis that develops in older adults
- Rheumatoid arthritis-this is a system-wide autoimmune disease that affects the joints.
- Arthritis-Ankle arthritis is typically caused by injury to the ankle, the result of some kind of trauma such as a bad fracture, or chronic trauma such as repeated ankle sprains which lead to the cartilage degeneration.
Ankle fusion (arthrodesis) used to be the only surgical option to treat ankle arthritis and pain. But ankle replacement, also known as ankle arthroplasty, has become a much better option with better pain relief, faster recovery time, preservation of motion, more natural motion, and more patient satisfaction. In ankle replacement, damaged portions of bone and cartilage in the joint are removed and replaced with advanced 3-D custom-printed implants. Total ankle implants are more anatomical now than years ago. This means that they restore the normal anatomy of the ankle and require only minimal bone tissue to be removed. Instruments to perform the surgery have also significantly improved to be more accurate. Because the artificial ankle joint is designed to closely mimic the natural movement of the ankle, one can walk with a more natural gait and experience less pain and a greater range of motion. All these factors have resulted in much better outcomes.
Commons symptoms of ankle arthritis include:
- Difficulty walking
- Joint pain
- Joint swelling
- Pain that may increase with activity
- Stiffness or loss of mobility
- Deformity of the ankle
Most people find relief from ankle pain and other symptoms with basic treatments, often used together. RICE-rest, ice, compression, and elevation can usually relieve joint stiffness and pain. Special shoe inserts or braces, nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Aleve, corticosteroid injections, and physical therapy and limiting high-impact activities such as running, jumping, or court sports can help, but often only to a certain point when the damage to the joint makes ankle replacement a severe consideration.
WHEN IS SURGERY INDICATED?
When conservative treatments don’t offer real results, ankle replacement might be the only option that will. In the surgery, the surgeon removes the ends of the damaged bones and fits a metal and plastic replacement joint onto them. Total ankle replacement is typically an inpatient procedure, but you might need to spend one night in the hospital. The patient will be given general anesthesia or a nerve block so that no pain or discomfort will be felt during surgery. In the first weeks after surgery, the leg should be kept elevated, and no weight should be placed on the foot. After four weeks, it will most likely be possible to begin walking in a boot and begin physical therapy, followed by being able to wear regular shoes and begin limited activity.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Only a highly-skilled orthopedic surgeon should perform total ankle replacement. It isn’t just their skill but their knowledge of the newest cutting-edge techniques. Ankle surgeons at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, perform high volumes of all ankle surgeries. Their expertise in ankle replacement is unmatched. Because they have extensive experience with all the latest technology and procedures, they are also able to recommend total ankle replacements to people who would not otherwise be considered candidates. It all begins by ensuring an exact diagnosis taking into consideration a patient’s age, overall medical picture, activity level, and level of pain. Advanced imaging, such as a CT scan or MRI, will further help determine the proper individualized procedure for each patient. Healing from ankle surgery can be a lengthy process, with full recovery varying from patient to patient. Still, at CCOE, you can be sure they will be there for you with advice, care, comfort, and support all along the way.