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Ankle Replacement Surgery (Ankle Arthroplasty)

Reviewed by
Dr. Matthew Garoufalis

Medically known as ankle arthroplasty, ankle replacement surgery involves replacing damaged parts of the three bones that make up the ankle joint (the talus, tibia, and fibula) with prosthetics.

Although early designs of prosthetic ankles had high failure rates, recent studies conducted in both the US and Europe indicated a 92 percent success rate.

Ankle prosthetics come in various sizes. Early prosthetics featured a two-component design, and although some models still do, most manufacturers now offer a three-component design.

The three components include two bone-anchored metal components and one polyethylene meniscal bearing interposed between them.

Ankle arthroplasty is reserved for patients who fail to respond to such conventional treatment as shoe modifications, physical therapy, limited activity, and medication for pain and inflammation.

Ankle Replacement Surgery

Why Ankle Replacement Surgery is Performed

The ankle joint is usually replaced when it is severely damaged. In many cases the pain is severe and persistent and the ankle may become immobile. Causes of damaged ankles may include:

  • Arthritis that develops after ankle surgery
  • Osteoarthritis
  • Rheumatoid arthritis
  • Infection
  • Bone fracture
  • Rejection of arthrodesis (a conventional treatment that involves fusing the bones together)
  • Failure to respond to conventional treatment such as physical therapy
  • Severe bone deformity
  • Weight in excess of 250 lbs

The Ankle Replacement Procedure

General guidelines on the day of surgery are pretty much the same for everyone. Do not eat or drink anything for six to twelve hours before the surgery, and take the medication your doctor gives you.

Before the procedure begins you will be given general anesthesia or a spinal anesthesia. General anesthesia puts you to sleep; spinal anesthesia numbs you from the waist down.

Once you are numb, the surgeon will make an incision in the front/top part of your ankle to expose the joint.

Once the ankle joint is exposed, the surgeon will remove the damaged parts of the bones after the nerves, tendons, and blood vessels are moved aside. He or she will then shape the bones to prepare them for attachment of the prosthesis.

Using a special bone cement/glue, the prosthetic ankle is set in place and screwed into the bone. The screws provide extra strength and durability. The doctor will then use sutures to close the incision.

In most cases, patients are hospitalized for two to four days after the procedure. While you are in the hospital, your ankle will be put in a cast and elevated above your heart to help minimize the swelling. Typically, a tube is inserted to drain the blood from the surgical site for the first couple of days.

After Ankle Replacement Surgery

Once you are released from the hospital, you will begin a physical therapy routine to regain strength in your ankle and to improve your ankle joint’s mobility.

How long the prosthetic ankle lasts will depend on factors such as how active you are following surgery, your health, and how damaged your ankle joint was prior to surgery. Newer designs usually last about ten years.

Complications of Ankle Replacement Surgery To Know About

Various complications can occur during and after ankle arthroplasty. During the surgery blood clots can develop, and excessive bleeding can occur.

The following complications may not develop until after the surgery is over and may include:

  • Allergic reaction to the prosthetic
  • The prosthetic may dislocate or dislodge from the bone
  • Nerve damage
  • Instability of the ankle
  • Fractured bones
  • The prosthetic may loosen over time
  • Ankle weakness and/or stiffness
  • The skin may not heal properly over the surgical site

There are things you can do to reduce the risk of complications. For example, if you smoke you may want to reduce your tobacco consumption.

Smoking slows down the healing process and lowers your immune system’s ability to fight infection. Those with chronic illnesses such as diabetes may also be at a higher risk for problems. Be sure to inform your doctor of all medications and supplements you take prior to surgery.

Contact your doctor immediately if:

  • Pain, swelling, redness, drainage or bleeding increases at the surgical site
  • You develop signs of an infection, including headaches, dizziness, muscle aches, or a fever
  • New, unexplained symptoms develop
  • You are concerned or have questions

Talking to Your Doctor

Here are some questions to ask your doctor about ankle replacement surgery:

  • Which medications am I allowed to take on the day of surgery?
  • How long after the surgery will my family have to wait before they can see me?
  • Will you recommend a physical therapist or should I pick my own?
  • How long will it be before I can resume my normal activities?
  • After surgery, when will I be able to eat and drink again?
  • If surgery fails, what are my next options?

Did You Know: The ankle may be the most important joint in the body. Without it, it is impossible to move around. Learn more about the ankle bones and how they help you stay mobile here.

Medical References:

    H. Winter Griffith, MD “Complete Guide to Symptoms, Illness & Surgery, Revised 5th Edition” (The Berkeley Publishing Group, 2006) 726 Aetna, Total Ankle Arthroplasty, National Institutes of Health, Ankle Replacement,

This page was last updated on October 2nd, 2015

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