Total Ankle Replacement: Frequently Asked Questions

What is total ankle replacement?

A total ankle replacement is an artificial joint that resurfaces both sides of the ankle joint to relieve pain caused by arthritis and maintain range of motion of the ankle. The ankle joint connects the leg to the foot and is made up of a cartilage covered surface at the end of the tibia (or shin) bone which joins with a cartilage covered surface on the talus (or ankle) bone. A total ankle will replace the cartilage on these two surfaces with a metal on polyethylene (plastic) “bearing” surface that are firmly attached to the bone. Motion between these two joint surfaces is what allows the up and down movement of the foot. When an ankle joint replacement is performed it will only resurface the ankle joint itself and would not be expected to help arthritis pain that is coming from joints of the foot.

Who is a candidate for a total ankle replacement? 

The best candidate for an ankle replacement is a healthy person with painful ankle arthritis. There are requirements for your overall health to be ready for ankle replacement to reduce the risk of complications. These include good blood glucose control if you are diabetic, being a non-smoker and having good blood flow to the foot. In general, high-intensity activities, like running and jumping, is not recommended after ankle replacement. Ankle replacements can wear out over time and may require further, sometimes more complicated, revision surgery. In addition, a misaligned or crooked ankle or foot may increase your chances of complication or require that additional surgical procedures are required to achieve success. In these cases, ankle replacement may not be a viable solution for ankle arthritis.

What are the advantages and disadvantages of total ankle replacement in comparison to ankle fusion?

Ankle fusion has been a solution for severe arthritis of the ankle for many years. This operation provides reliable long-term relief of pain and can also be used to correct deformity related to arthritis. Although ankle fusion results in loss of motion at the ankle joint, most people walk normally without a significant limp. This loss of motion at the ankle, however, can potentially cause arthritis in other joints in the foot over time. The primary advantage of ankle replacement is that preserving some motion at the ankle joint will provide more normal function and protect the other joints around the ankle from becoming arthritic. It is possible that you will require additional surgery on your ankle depending on your age when the ankle is replaced or fused.  

Why do total ankle replacements sometimes need to be performed in two separate staged procedures?

Many patients who desire TAR for painful ankle arthritis also have arthritis or deformity of other joints in the foot or they may have hardware present from previous surgeries. The primary goal for TAR is pain relief, and therefore any other sources of pain need to be addressed to expect a good result from surgery. Fusions of other, less essential, joints in the hindfoot or midfoot may be needed to achieve pain relief. Hardware may need to be removed prior to TAR to make performing the replacement possible. In addition, if the ankle or foot has a deformity such as a tight Achilles tendon, an ankle that turns out, or a severe flat foot, the stress on the new ankle replacement will be excessive and can lead to an early failure. In some cases, additional procedures can be done at the same time as the TAR surgery. However, in many cases, these additional surgeries are extensive and require healing time before the TAR is performed, thereby requiring two staged procedures separated by weeks or months. 

If I have an ankle joint fusion now, can my ankle be converted to a total ankle replacement in the future?

The short answer is, ‘yes’, in that it is technically possible, however it should be considered very carefully. If you are not experiencing pain at your ankle after a successful fusion, then conversion to an ankle replacement to obtain more ankle range of motion would not be recommended. On the other hand, if you have a painful ankle fusion with a complication such as the bone not being healed or in the wrong position, conversion to a replacement may be considered. However, you should proceed with caution when considering conversion of an ankle fusion to a replacement since it is an uncommon surgery that has increased complications, and the results would not be expected to be as good as with a traditional ankle replacement. The decision as to whether this type of conversion surgery is an option is a complex one that you should have with your surgeon.

How long can I expect my total ankle replacement to last?

Recent studies have shown as high as 90% of total ankle replacements are still intact at 10 years after surgery. Longevity of the ankle replacement seems to be better in those patients who have less deformity of their ankle going into the surgery, as well as for patients over age 50. True long-term outcome of the most modern total ankle replacements is not yet available, meaning, we really do not know what the results will be at 15 or 20 years after the operation. If undergoing an ankle replacement surgery, it is expected that about 25% of patients will need a repeat surgery for some reason at 5 years after surgery and 10-20% of patients required a second (revision) ankle replacement at 10 years after the first surgery.