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Is Ankle Replacement Surgery Right for You?

Learn the benefits over traditional fusion surgery.

Photo credit: Getty Images

Joint and bone pain don't have to be a part of normal life.

Dear Doctor,

I played soccer throughout high school and college, and sprained my left ankle a couple of times. Then in my 40s, I injured it again while running, and it’s been bothering me on and off ever since. Wearing an ankle brace helped a little, but now, at age 60, the pain has become so bad that I’ve had to give up running. I’m curious about ankle replacement surgery. Is it worth considering?

“Ankle Agony”

Dear Ankle Agony:

Your situation is a very common one. My typical patient with chronic ankle pain is often someone in their 50s or 60s who was a varsity athlete in high school or college and became a “weekend warrior” in the working world. They might start off with a mild sprain or fracture, but if there is continual damage to the ankle joint, over time this can lead to a breakdown and inflammation of the joint, which is called arthritis.

When I meet with a patient with ankle arthritis, I lay out the entire treatment spectrum. This includes everything from over-the-counter ankle bracing and custom “Rolls Royce” braces to activity modification, medication, injections and even surgery, if the more conservative measures don’t help.

In the past, the traditional surgery for ankle arthritis has been ankle fusion, which involves gluing the two main ankle bones together and securing the fusion with plates and screws. The downside is the elimination of the range of motion at the joint. Another consequence is that you can develop joint arthritis in the joints that are adjacent to the ankle.

If you want to be able to retain full range of motion in your ankle joint, then you should consider joint replacement surgery. Hip and knee replacement surgeries have been around a lot longer and are much more common, but as joint replacement technology improves, as well as our understanding of the anatomy of the ankle joint and the biomechanics that allow replacement materials to mimic the actual motion of the joint, ankle replacements have become more popular.

In addition to preserving range of motion, the other big advantage of ankle replacement over ankle fusion is the shorter recovery time. With joint fusion surgery, you have to be off your feet and immobilized for six to eight weeks, and sometimes longer. That’s because the bones take that long to fully heal.

With ankle replacement surgery, there’s no healing time involving bone to bone contact because you are putting plastic and metal in between the bones. Most patients who have ankle replacement surgery are immobilized for about two weeks, and from there they move on to a walking boot and can begin physical therapy, which usually lasts a few months. After that, you can resume your normal activities, although I usually recommend avoiding high impact activities such as running, because that can make the joint wear out faster.

The main drawback with replacement surgery for ankles is that the joint materials wear out quicker than hip and knee joints. Today’s knee and hip joints usually last about 25 years, while the newest generation of ankle joints last only 10 to 15 years. However, as the technology advances, we expect the life span of ankle joints to increase.

To learn more about which treatment option makes the most sense for you, I recommend meeting with an expert who specializes in foot and ankle surgery.

“If you want to be able to retain full range of motion in your ankle joint, then you should consider joint replacement surgery.”
Dr. Adam Bitterman, orthopaedic surgeon
Dr. Adam Bitterman, orthopaedic surgeon. | Photo credit: The Well

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Published September 14th, 2018

Joint and bone pain don't have to be a part of normal life.