An ankle replacement is a procedure to treat ankle arthritis after chronic instability, trauma, or a variety of arthritic conditions. It involves replacing the articulating surfaces of the tibia, the fibula, and the talus, and a heel cord lengthening is typically added to improve overall motion. Ligamentous balancing and bone grafting procedures may also be required.
Pain relief after total ankle replacement is excellent, and gait improves significantly because of decreased pain. Decreased stress to the adjacent joints (with decreased risk of arthritis) represents a major advantage of replacement over ankle fusion.
Do you need to undergo total ankle replacement to address pain or dysfunction as a result of arthritic degeneration or injury?
If so, let Dr. Silverman help.
For more information about total ankle replacement surgery, keep reading.
What Happens Before Total Ankle Replacement Surgery?
You’ll be given specific instructions on how to prepare for your upcoming operation by the surgical center. On the day of surgery, you will receive regional anesthesia known as a popliteal nerve block. This is a procedure performed by the anesthesiologist prior to your operation. You will be placed on your stomach and injected with a Novacaine-like medication around the nerve in your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given antibiotics just before surgery to help prevent infection.
What Happens During Total Ankle Replacement Surgery?
During surgery, you will undergo general anesthesia. A tourniquet is placed around your thigh. An alignment jig is attached to your leg and removed before the end of the procedure. Incisions are made along the front and back of your ankle and leg. The ankle cartilage and degenerative bone is removed and replaced with the ankle prosthesis. Other indicated surgeries may be performed simultaneously. X-Rays taken during the surgery confirm the implant position. The wounds are closed with staples and the patient is moved to a recovery room.
What Happens After Total Ankle Replacement Surgery?
You will be permitted to leave the post-anesthesia center in a protective splint once your anesthesiologist is satisfied that you have recovered. A physical therapist will teach you how to use crutches or a walker on the hospital floor prior to discharge. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wear off. Remember post operative pain is much easier to control with prevention.
Total Ankle Replacement General Recovery Timeline
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months. |
| Motion | Move your toes and knee when the block resolves. This will decrease pain and swelling, and improve healing. Begin ankle motion at 2 weeks. |
| Walking | If you are healing well begin partial weight bearing at 6 weeks in cast when you have permission. |
| Bathing | Keep cast dry. Use a DryPro. There are no restrictions after the cast is removed. |
| Pain Control | Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only). NSAIDS will slow healing. |
| Work | Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor is not recommended after total ankle replacement. |
| Driving | Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe. |
Routine Clinic Visits
| 2 weeks | X-ray, cast and staple removal; obtain a fracture brace. |
| 6 weeks | X-ray, earliest time of bone healing to permit weight bearing activity. The time to return for your next visit varies significantly. |
| 3+ and 6 months | Return for recheck; strength improves over the next year. Minimal feelings of discomfort may linger, your overall comfort level improves over a year. |
| 1 year | Return for an annual check every year following your surgery. |
| ********** | If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office. |
Before surgery consider ordering a Full-leg Drypro, a waterproof cast sock.
For more helpful tips, check out these rehab exercise videos that will help you recover, or reach out to Dr. Silverman for more information!