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Ankle Joint Replacement

Ankle Joint Replacement
Ankle pain can be caused by a variety of factors – some far more common, less serious and more easily treatable than others. Given its crucial role though in our everyday mobility, a painful ankle can quickly prevent us from performing the most mundane of activities, becoming an inconvenience at the very least, if not far more serious.

A wide range of different treatment options exist – some may be carried out at home and others will require specialist attention, and maybe even surgery. The information below is intended to act as a general guide to take you through the steps you can take to address your condition.

Your anatomy
Given its position at the base of the body, the ankle has to be a very strong and stable joint to take the strain of the weight placed upon it. It is composed of three bones: The tibia, the fibula and the talus.

The ankle is situated at the junction between the base of the tibia in the lower leg and the talus at the back of the foot, above the heel (calcaneus). The talus allows the foot to move upwards (dorsiflexion) and downwards (plantarflexion) like a hinge. The ankle, with the other joints of the foot, provides us ability to invert (turn in) and evert (turn out).This is necessary for walking with a smooth and effortless gait on various surfaces.

The joint surfaces are covered by a smooth, tough material called cartilage, which allows the bones to glide easily over each other. The cartilage in the ankle joint is vital for shock absorption, cushioning the bones and ensuring the joint operates smoothly and painlessly. Bursae, fluid-filled sacs, cushion the area where tendons glide across bone. The ankle is also covered by a thin, smooth tissue liner called synovial membrane, which secretes a small amount of synovial fluid which lubricates the joint, further reducing friction and facilitating movement. The ankle functions correctly when everything works normally and in harmony. However when one part becomes damaged through either injury or disease, it can lead to problems and pain in carrying out everyday activities.

Normal body movements rely on joints working smoothly and without pain – maintaining maximum joint function allows us to enjoy an active and fulfilling lifestyle. We expect our ankles to support heavy weight, walk great distances, twist, turn and bend in every direction. We take this joint for granted and it is not uncommon to push it beyond its limit, particularly when playing sport.

Ankle Pain
Due to the crucial role that our ankles play in the most elementary of activities, such as simply walking and standing, ankle injuries should be taken seriously and treated properly, particularly as it is one of the most commonly injured joints of the body. There are several causes of pain within the ankle. Some mechanical problems can arise as a result of an injury or sudden movement that places too much stress on the joint, straining it beyond its normal range of movement. Arthritis can arise as a result of damage to the cartilage.

Severe joint pain due to arthritis can detract greatly from feelings of wellbeing and quality of life. Most successful treatments consist of a combination of approaches designed to take account of your own individual circumstances, needs and lifestyle, focusing on identifying ways to manage your discomfort and improve joint function. It is essential that the source of your ankle pain is first diagnosed by a medical practitioner to ensure correct treatment protocol. If ankle osteoarthritis is diagnosed, the following non-surgical treatment options are available, depending on the degree of joint disease:

Exercise and physiotherapy
Footwear, orthotics and bracing
Injection therapy
Diet and weight management

Whilst these non-surgical options for treating arthritis can help to provide short-term relief, if what you really need is an ankle replacement, they may only offer limited effectiveness compared to the long-term gains afforded by surgery.

Surgical treatments
When non-surgical treatment solutions such as medication, bracing, activity modification or diet and weight management no longer offer sufficient pain relief, it may be time to consider surgery. Surgery is only really recommended when the pain and disability are having very serious effects on your daily activities.

As a progressive disease, a range of different surgical approaches exist for the treatment of arthritis. Arthroscopic (keyhole) surgery may be appropriate in the early days. However, when the arthritis is at a more advanced stage, you may be recommended an ankle replacement or ankle fusion (arthrodesis). An orthopaedic surgeon is the only person who can advise on the most appropriate course for your own individual circumstances. Not all surgeons offer all treatments though, so it is important to ask to be referred to a surgeon who offers the options you wish to consider. Always remember that you, the patient, have the final decision on whether to go ahead if ankle surgery is offered.

Some people delay surgery due to fear, misinformation or a lack of awareness about their treatment options. However, there is no cure for osteoarthritis and it is also degenerative – meaning that any pain and limited mobility you are experiencing may get worse over time.

Until relatively recently, there were few surgical options for patients with painful arthritis in the ankle joint. Ankle fusion was the most common, whereby the tibia and talus bones (and sometimes the fibula) are fused together. Ankle replacement offers a more flexible solution, akin to hip or knee replacement. The surfaces of the bones are resurfaced with metal prostheses and a plastic insert replaces the role of cartilage within the joint, permitting a greater range of motion than is possible with ankle fusion.

Whilst both fusion and ankle replacement may relieve the severe pain that can accompany later-stage arthritis, the decision to go down the route of surgery should be made very carefully. Make sure you speak to your doctor in detail about the ankle joint, arthritis and the operative procedure involved.

Depending on the level of damage you have, there are a number of alternative solutions to help reduce pain and restore movement.

Recovery and Rehabilitation
Following an ankle replacement or fusion, you will usually be discharged from hospital three to five days after your operation, depending on how well you are healing. It is quite natural to feel apprehensive and you should make sure that you have been given full instructions about post-operative recovery. The post-operative regime varies from surgeon to surgeon and so it is therefore really only possible to give general advice here.

How quickly you return to ‘normal’ will depend on the individual – your age, overall state of health, muscle strength, your success in using crutches, etc. Before you leave, you will be given an appointment for the outpatients clinic – this is usually between six and 12 weeks after your operation. This appointment is a routine check-up to ensure that you are making satisfactory progress. It is likely that you will also be offered physiotherapy to aid in your rehabilitation and improve your recovery time.

Once you return home, you will need to continue to take your painkillers if you need to, as advised by your surgeon. You will need to take some time to adjust – so don’t feel guilty about relaxing. Swelling is common after ankle surgery so try to elevate your leg/foot when resting, preferably above the level of your heart. Bathing is obviously important, but you must take special precautions to ensure that you do not get your plaster wet – protect the ankle from water by wrapping it in plastic over the dressing. At night you should lie on your back, raising your ankle up using a couple of pillows. It is important to do some level of activity as well though, just be careful not to overdo it – follow your surgeon’s or physiotherapist’s advice.

Improvements can continue for a year or more, depending on your condition prior to surgery. It is important that you take regular exercise to build up the strength of the muscles around your new ankle. However, it is essential that you listen to the advice of your physiotherapist as to the suitability of different forms of activity so as to avoid damaging or dislocating the new joint.

By around 12 weeks it should be possible to resume low impact, weight-bearing activities such as walking, swimming, golf or gentle cycling. Avoid rigorous sports that put undue stress on the joint. Typically you will be able to return to almost all previous normal pastimes within a year of your operation. Ask your physiotherapist, doctor or surgeon if you are unsure about the suitability of any activity.

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Patient guide ankle Corin. This article is sponsored by Corin Group Plc. Corin would like to acknowledge and thank the following orthopaedic surgeons for their valuable contributions in producing this guide for patients.
Mr Shashi Garg (Royal Lancaster Infirmary, Lancaster)  Website
Mr Ian Winson (Southmead Hospital, Bristol)  Website
Corin Group Plc  More Information  Website

Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.