Ankle Arthroplasty: Helping People Live More Active, Pain-Free Lives

You’ve heard of hip and knee replacements, but what happens when the pain is further down your leg?

Ankle pain is tough: It is hard to participate in activities that require you to be on your feet. For many years, there weren’t good options for relieving ankle pain. When therapy or steroid shots stopped working, doctors would fuse the ankle bones together – leaving patients unable to bend their ankle or have a normal gait moving forward.

More recently, surgeons have offered a total ankle arthroplasty – or an ankle replacement. With this surgery, doctors remove damaged bone and cartilage before replacing it with stronger prosthetic parts. The new ankle is designed specifically to move like an ankle joint, so that patients can lead more active and pain-free lives than they ever would have before.

But traditional approaches to that surgery come with some disadvantages. That’s why in my practice at OrthoIllinois, I’ve made a point of specializing and implementing a new approach: Namely, an incision along the side of the ankle, rather than the front.

This technique allows for better wound healing because the incision is in an area that has less flexion motion and less mobile structures that cause tension to the skin. It also allows me to better visualize and replicate the ankle’s natural curvature. Beyond providing a better fit for the implant, this technique also reduces stress across the bone.

During surgery, the damaged bone is removed, and the prosthetic implant is set into place. The implant has a special metal surface that allows for bone to grow into the implant itself, securing it firmly over time to the native bone. Deformity to the fibula bone is corrected and fixated back in place using a metal plate and screws. Patients generally remain non-weight bearing for about three weeks after surgery, then move to a walking boot for another month. After that point, my goal as a physician is to see patients move forward with physical therapy to regain strength and mobility.

Although it commonly is the better approach for most patients, not everyone qualifies for the side-incision technique. I might return to a front incision for the rare patient whose fibula is highly distorted, or who has a complication that requires a larger incision.
Of course, surgery is a last-ditch resort, after we first try less invasive therapies such as wearing a brace or using anti-inflammatory medication. If those interventions fail, I consider factors such as your physical condition, age, weight and activity level to determine whether an ankle replacement is the next best step.

For all patients, regardless of age, my goal with an ankle arthroplasty is to give patients the option to resume an active, healthy lifestyle without pain holding them back. It’s rewarding to see patients who are accustomed to chronic ankle pain return to their lives without limitation.

It is, indeed, a game changer.