Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Ankle Replacement in India


Ankle Replacement

Total ankle replacement surgery is a safe and effective treatment option for select patients with ankle arthritis. Total ankle replacement surgery substantially improves function, reduces pain, and allows for an improved quality of life. Patient mobility and quality of life factors improvement contribute to longer independent living and to controlling overall health care costs (AOFAS Statement).

Who can do Ankle Replacement or Ankle Arthroplasty?

Ankle replacement is a demanding operation. Only orthopaedic surgeons with complete knowledge of foot and ankle mechanics should undertake this surgery. Ankle replacement training and surgery is different than hip and knee replacements. It is less forgiving and has less margin of error. Hence only orthopedic surgeons with dedicated foot and ankle training and practice should undertake ankle replacement surgery.

What is Ankle Replacement?

Ankle replacement involves resurfacing arthritic ankle joint and with metal surfaces with a plastic insert between the two surfaces. Ankle replacement as compared to Ankle Fusion maintains movements in the arthritic joint thereby giving you near normal walking. About 5000 ankle replacements are done in USA every year. Dr Bhargava has been trained in these types of Ankle Replacements and can help you choose which is best for you.

 
Components of Ankle Replacement1
  Components of Ankle Replacement2  
         
 
Components of Ankle Replacement
            3
     

How does the Ankle Replacement work?

The current design of ankle replacement has three components. Two of the components are fixed and cover the bones. Between the two fixed metal components is a third mobile component which is responsible for movement and reducing the stress on bone implant interface.

 
X-ray showing Ankle Replacement
     

The metal component which covers the top bone of ankle joint called tibia is flat. It is attached to the bone with a help of a small stem. The part which covers the bottom bone of ankle joint called talus is curved and is attached to main bone via small tooth like pegs. Both these components are coated with a special layer called hydroxy-appatite which creates strong bonding between bone and metal.

Ankle replacement operation helps patient to preserve their own ankle movement. In addition they gain few more degrees of movement because their muscles work better when their ankle pain is relieved by surgery. Success of this particular type of ankle replacement is because of the way it integrates with the bone. The presence of mobile insert enhances mobility and longevity of the prosthesis.

What are the indications of Ankle Replacement?

Severe arthritis pain in the ankle joint and ankle swelling which affect one’s life and day to day activities significantly. Generally patients should be over the age of fifty however the age of fifty is not an absolute figure. Hindfoot deformities are not a contraindication for ankle replacement.

What are the benefits of Ankle Replacement over ankle fusion?

1.
Ankle replacement provides excellent pain relief while preserving joint movement. As joint movement is preserved it maintain near normal mechanics and walking. Hence your gait is better after ankle replacement than after fusion.
 
2.
Also other foot joints adjoining the ankle replacement are not overloaded and hence they work better as compared to than in fusion.
 
3.
There is also less chance of adjoining joints developing arthritis as shown in the picture
 
4.
Bilateral ankle arthritis and generalised arthritis as seen in Rheumatoid arthritis patients and in Haemophiliacs ankle replacement is a better option than fusion.
 
  Ankle Fusion with secondary hind foot arthritis      

What are the alternatives to replacement?

The most common operative alternative is an ankle fusion. However other options do exist such as arthroscopic debridement and external fixator joint distraction (see ankle arthritis, other options).

Frequently Asked Questions

  1. Am I suitable for an ankle replacement?
    Pain at the ankle is reliably relieved by ankle replacement. To find out if you are suitable for a replacement you need to be seen by Dr Bhargava.
  1. How long will I stay in Hospital?
    You usually remain in hospital for 2-3 days after the operation.
  1. How long does the operation takes?
    The operation usually takes approximately 2 hours.
  1. What is the post-operative recovery?
    All patients are immobilised in plaster for the first two weeks post-operatively. Then depending on what was involved in the surgery patients will either go into either a walker boot or alternatively another plaster. At 6 weeks most patients are fully weight bearing. The ankle often remains slightly swollen for a number of months post-operatively but this eventually settles.
  1. What will I be able to do after the ankle replacement?
    Most patients are able to walk few kilometres comfortably. They sleep without pain. Many patients resume activities like dog walking, and golf.
  1. How long will it be before I can drive?
    Patients are able to drive after 6 weeks.

Case Diary

Here are few examples of patients who have benefitted from ankle replacement operation.

Case 1
This man had an injury to his left leg and fracture of his leg bones treated with a plaster. His injury happened 20 years ago. He recovered well from his injury but eventually developed arthritis of the ankle. He is very active and enjoys playing golf.

 
X-ray picture showing Ankle Arthritis and heel deformity secondary to previous Tibial Fracture1
 
X-ray picture showing Ankle Arthritis and heel deformity secondary to previous Tibial Fracture2
 
         
 
X-ray pictures of hind foot Arthritis patient after Ankle Replacement1
 
X-ray pictures of hind foot Arthritis patient after Ankle Replacement2
 
   

He opted for ankle replacement surgery over ankle fusion when pain in his ankle started affecting his walking and day to day activities. He was able to resume all his activities after operation and his very pleased with the result.

Case 2

 
X-ray picture showing Ankle Arthritis and heel deformity secondary to previous Tibial Fracture
 
X-ray picture showing Ankle replacement and simultaneous correction of Heel deformity
 
         
 

This 72 year old man had fracture of his lower leg treated with surgery long time ago. He developed arthritis of ankle with deviation of his heel. He was complaining of pain and giving way of his ankle. His surgery involved ankle replacement. At the same time his heel was corrected so that he can walk with straight leg and ankle stops giving way.

Case 3

This 62 years lady suffered with Rheumatoid Arthritis. This type of arthritis affects all the joints. She initially came with complaints of pain in her hindfoot subtalar and talonavicular joints. She underwent triple fusion surgery which reliably relieved her symptoms. After 4-5 years she started developing pain in her ankle. Note that the ankle arthritis has worsened over time(reduced joint space).

X-ray of Rheumatoid Arthritis patient showing hind foot arthritis
 

X-ray of same patient showing progression of ankle arthritis 4 years following triple fusion

X-ray following ankle replacement in patient with previous triple fusion
     
X-ray following ankle replacement in patient with previous triple fusion
 
X-ray following ankle replacement in patient with previous triple fusion2

She had ankle replacement. An ankle fusion operation in her case would have stiffened all her hindfoot joints and would have affected her walking and gait considerably. She is very happy with the result of her replacement.

Patients with bilateral ankle arthritis and generalised arthritis as seen in Rheumatoid arthritis patients and in Haemophiliacs ankle replacement is a better option than fusion.

Case 4

Varus osteoarthritis of Ankle

Usually is more common in asian population presumably because of their varus aligned knees and a tendency to sit in a lotus position with their legs crossed, as well as kneeling with the ankle in plantar flexion and inversion. Another important cause of varus ankle arthritis is recurrent ankle sprains. Clinically the patients have inward deviation of heel and deformity can either be congruent or incongruent.

In an incongruent varus ankle, the mortise is usually in almost neutral alignment (picture) with the varus deformity due to talar tilt. Since this is caused by medial contracture and/or lateral laxity, optimal balancing of the ligaments can produce a neutral ankle. If this can be achieved by adequate medial release, no further additional procedure is necessary. If there is residual talar tilt with lateral opening even after sufficient medial release, lateral plication procedures are needed.

     
X-ray showing varus osteoarthritis of Ankle
              X-ray after ligament balancing and ankle replacement