What is total ankle arthroplasty?

Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle arthritis. Arthritic changes may be a result of normal wear and tear due to aging or from an injury such as a broken ankle or dislocation. Arthritis eventually leads to loss of cartilage, pain, and/or deformity.

What is the goal of TAA?
The goal of TAA is to provide pain relief while preserving ankle motion so the patient has less pain and better function during activity.

Surgical photo of an ankle replacement

What signs indicate TAA may be needed?
TAA is considered for patients who continue to experience ankle pain and decreased function from arthritis after trying conservative management. Conservative management includes anti-inflammatory medication, bracing, physical therapy, activity modification, and injections. TAA is a motion-sparing option, in contrast to a fusion-type procedure that would eliminate the motion at the ankle joint.

When should I avoid a TAA?

TAA is not suited for patients with severe deformity or dead bone in the talus (the bottom bone of the ankle joint). Other signs that TAA should be avoided include a history of deep infections of the ankle, significantly abnormal nerve function or sensation (also known as peripheral neuropathy), inadequate or absent leg muscle function, and poor blood flow of the leg.

What can I expect during the procedure?

TAA is performed either under general anesthetic or nerve block. A tourniquet is used at the time of surgery to control bleeding and improve visualization during the surgery. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that recreate the ankle joint. Sometimes additional procedures will have to be done at the same time to ensure the foot and ankle are properly aligned and the deformity is corrected. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implants to heal in place.

What happens after surgery?

Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The procedure is usually
performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for many days after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, some foot and ankle orthopaedic& surgeons will allow the patient to start working on gentle range-of-motion activities even if they are non-weightbearing. Weightbearing usually begins a few weeks after surgery if X-rays show good healing.

What are the potential complications?

There are complications that relate to surgery in general. These include risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication of ankle replacement. Wound healing is critical in the early weeks as issues with wound healing can lead to superficial or deep infections. Patients who smoke or have diabetes or rheumatoid arthritis are at greater risk for these issues. Another complication that is sometimes seen is the failure of the ankle implant to heal into the bone.

Like knee and hip replacements, ankle replacements involve artificial parts that may loosen or wear down over time. This can lead to infection and other issues, even years after the initial surgery, that require additional surgery.

Frequently Asked Questions

There are two surgical approaches for treatment of end-stage ankle arthritis: ankle fusion​ and total ankle replacement. Why should I consider an ankle replacement?

There are many factors that affect this decision, so you should discuss your case with a foot and ankle orthopaedic surgeon before pursuing treatment. In general,when motion of the ankle is preserved in a TAA, the surrounding joints are protected from increased wear. This is especially important if there is arthritis in these neighboring joints already.

The number of ankle replacements being performed is increasing dramatically, with published and ongoing research increasing along with it. Newer implant designs and improved surgical techniques are constantly evolving with the goal of helping patients.