Until recently, patients with severe arthritis of the ankle, a leading cause of chronic disability in North America, have been limited in their treatment options. Traditionally, an ankle fusion has been the response to severe ankle arthritis when non-operative treatments have failed. While a fusion provides reliable pain relief and improved function, the patient still struggles with immobilization of the joint, compromised function and even accelerated degeneration of adjacent joints.
But thanks to a new generation of effective implants with longer life-spans, foot and ankle doctors at Midwest Orthopaedics at Rush (MOR) are recommending ankle replacement surgery, also called ankle arthroplasty, for many qualified patients suffering from chronic or debilitating arthritis and/or ankle disabilities.
In general, ankle replacement is gaining popularity among patients with severe ankle arthritis who have hobbled around for years. From 2010 to 2011, ankle replacement procedures more than doubled in the United States alone as the design, technology, surgical methods and reliability continued to evolve. The MOR foot and ankle physicians successfully utilize the most proven, practiced and innovative surgical techniques to provide the best patient care. MOR is one of few groups of orthopedic surgeons in Illinois to offer ankle replacement surgery.
Who are candidates?
To qualify for ankle replacement surgery, a patient must be healthy and infection-free and have normal muscle control and sensation of the foot and ankle, sufficient skin coverage over the ankle and disabling ankle arthritis that doesn't respond to non-surgical treatments. Patients who undergo ankle replacement surgery can expect pain relief and renewed function in the ankle, which leads to a more comfortable and mobile life.
What happens during surgery?
During an ankle replacement, the patient will be given general, spinal, or regional anesthesia. The foot and ankle surgeon at MOR will make a skin incision at the front and on the top or on the side of the patient's affected ankle. The surgeon will remove the damaged cartilage and bone before resurfacing the three bones of the ankle — the lower end of the tibia and fibula and the top of the talus (foot bone) upon which the leg bones rest. This reshaping of the remaining bones provides room for the artificial parts to be implanted. The MOR surgeon will attach the new joint parts — prosthetic reproduction of the patient's natural anatomy — to the resurfaced bone. Screws may be placed through the fibula and tibia for additional support. Lastly, the foot and ankle physician will seal the incision with stitches.
What happens after surgery?
Ankle replacement patients generally stay one to three days at the hospital before being sent home with their foot in a splint. The patient must avoid putting any weight on the ankle implant until the soft tissues have healed and regained normal strength, typically a six-week period. Stitches are taken out between 7 and 21 days after surgery.
How much time is required for physical therapy?
Most orthopedic doctors recommend a rehabilitation program of 6-12 weeks that involves physical therapy exercises to strengthen the ankle and gradually increase the use of the ankle, which will help improve its range of motion. A full recovery often takes up to six months at which joint patients can expect great improvements in pain relief, coordination and mobility. Patients will be able to walk and do most types of exercise, except for running and impact activities.