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At Nuffield Health Cardiff and Vale Hospitals's Foot and Ankle Clinic, our surgeons specialise in a full range of Foot and Ankle conditions, including artitis of the foot / ankle, and treatment for this including Total Ankle Replacement.
Find out more about our Consultant Foot and Ankle Surgeons:
Arthritis in any joint occurs when the smooth cartilage surface that lines the joint wears away. In the hip and knee this can occur as part of normal aging and is known as ‘primary arthritis’. This is not so common in the ankle.
Ankle arthritis usually develops after an ankle fracture or repeated sprains that cause damage to the surface of the ankle joint. Because of his ankle arthritis can affect younger people who need to keep on working. Inflammatory arthritis, such as rheumatoid arthritis, may affect the ankle joint as well as other joints within the body.
Mr Thomas (Consultant Foot & Ankle Surgeon at Nuffield Health Cardiff and Vale Hospitals) has contributed a ‘Current Concepts Review’ on ‘Ankle Arthritis’ to the Journal of Bone and Joint Surgery. He has also written a chapter on this subject (Etiology & Biomechanics of Ankle Arthritis) in Foot & Ankle Clinics of North America. His current MD research project involves studying the biomechanics of ankle arthritis.
The success of hip and knee replacement has prompted the development of ankle joint replacements. Initial outcomes were not always good but with improved designs and instrumentation ankle replacement is becoming increasingly popular as results continue to improve. New generation ankle replacements are very similar in design to modern knee replacements.
Ankle joint replacement involves removing arthritic cartilage and bone from the joint surfaces of the tibia and talus. These surfaces are then replaced with metal components that will integrate with the bone to keep them in place. The metal components have stems or pegs that stabilize them in the bones. A mobile plastic bearing is placed between the metal surfaces to allow movement within the joint. An ankle replacement helps to maintain up and down movement at the ankle but also allows some rotation.
An ankle replacement is very much like an upside-down knee replacement!
This is an operation undertaken for those that have significant arthritis (degeneration) of the ankle joint with advanced symptoms such as pain and decreased walking.
An ankle replacement is most often considered for those patients that put less stress through their ankle. The best results are typically seen in patients over 60 and those with rheumatoid arthritis. It is important to have some movement in the ankle before the operation and not to have severe deformity.
Total ankle replacement is an alternative to ankle fusion. However young people that have developed arthritis as a result of an injury, and those involved in manual work, are often best suited to an ankle fusion. This is something that you should discuss in detail with your surgeon.
As the newer, successful ankle replacements have only been available over the last decade long-term results (over 20 years) are not available yet. However many studies show good performance of ankle replacements up to 10years.
Immediately after surgery you will be in a backslab plaster (half plaster) below the knee. You will usually be in hospital for 2 nights after your ankle surgery. You need to keep your weight off the ankle and will need to keep it elevated at home.
At 2 weeks your wound will be inspected. At this stage you will go into a removable boot and start to put weight through the ankle replacement with the aid of crutches. You should be able to remove the boot to shower. Physiotherapy will help you maintain ankle movement.
At 6 weeks the boot can be removed and normal mobility commenced. Improvement may continue for up to a year after the operation.
Unfortunately no surgical operation is free of complications. Total ankle replacement is a major surgical procedure just like knee and hip replacement.
The ankle replacement is put in through an incision on the front of the ankle. Infection or wound healing problems can occur. You will be given antibiotics before and after your operation to decrease this risk.
A deep infection that occurs around the ankle replacement itself is a serious complication. This may mean that the ankle replacement needs to be removed and converted to an ankle fusion.
A fracture can occur around the ankle replacement. Sometimes this occurs during surgery and can be dealt with at the same time as the ankle replacement.
Blood clots can occur after total ankle replacement. Our consultants follow the guidelines of the British Orthopaedic Foot and Ankle Society with regards to prevention of blood clots.
The commonest cause of delayed problems is mechanical loosening of the metal components. This may require conversion to an ankle fusion, or in some cases, a revision of the total ankle replacement.
Just like knee replacement, a small proportion of people may have pain that will continue after the operation despite no obvious cause being found for this.