​Total Ankle Replacement

This is an operation designed to replace the worn out, arthritic ankle joint with a prosthesis which aims to preserve movement and get rid of the pain. It involves a skin incision over the front of the ankle to gain access to the joint. The worn out cartilage at the bottom end of the tibia (shin bone) and the dome of the talus (ankle bone) is removed and replaced with a metal prosthesis with a specialised high strength plastic tray in between.

Type of procedure

This is an inpatient procedure and you will most likely be discharged in two to three days time.

Type of anaesthesia

The operation will be undertaken under a general anaesthetic supplemented with an injection regional nerve block. The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes about 2 to 2 1/2 hours.

General Recovery Facts

You will not be walking on the leg for 8 weeks

You will use crutches, a walker, a wheelchair or a scooter device called a roll-about

There will be a back slab ( half a plaster) applied to the leg for 2 weeks

Your first follow up visit will be at approximately 2 weeks to remove the stitches

We will usually apply a removable boot for you to wear at this time, but occasionally we use a short leg below the knee cast for a short period of time. If a cast is used, it is to keep the ankle stretched up and to prevent stiffness

If the surgery is on your left ankle, you should be able to drive an automatic vehicle at two weeks. If the surgery is on the right ankle, you may drive between 4-6 weeks

Exercises and range of movement of the foot and ankle are to be encouraged at about 2-3 weeks after surgery

If you have access to a swimming pool, we encourage you to use this as soon as the incisions are completely dry and healed, which will be at about 2-3 weeks. Swimming will significantly improve your recovery and allow you to begin bearing some weight on the leg in the pool. The best way to regain movement is to put fins or flippers on to the foot and move the ankle up and down in the water

You should remove the boot for twenty minutes three times a day to exercise

You will begin walking on the leg and ankle at about 6-8 weeks in a boot

You may begin to walk without the boot at about 8 weeks, depending upon your level of discomfort and instructions given to you by your doctor

Physiotherapy is very helpful and begins at 4-6 weeks

You should plan to use a phyiotherapist for about 1-2 months
There will be moderate swelling of the ankle and leg for about 6 months
The strength and movement in your ankle will continue to improve for about 9 months

Exercise and sporting activity after your total ankle replacement

For many individuals, a return to an active lifestyle is our goal following this surgery. For some, this may mean the ability to walk without pain, and for others, a more regular exercise routine may be more important. Regular exercise in a gym is always to be encouraged, and the use of all machines including bicycle, stair climber, and elliptical machines are excellent to regain strength and movement of the ankle. It is never recommended that you run. You may however engage in golf, prolonged hiking or walking, doubles tennis and bicycling, and under certain circumstances, skiing. An orthotic arch support is important for your recovery and this will be provided to you by our orthotist.

Specific post-operative recovery

Day 1Foot is wrapped in bulky bandage and splint, possibly a cast.
Ice, elevate, take pain medication
Expect numbness in foot 12-24 hours then moderate to severe pain
Bloody drainage through bandage is expected
Use crutches, walker, wheelchair or roll-a-bout
Do not change dressing/splint and do not get the leg wet

2 weeks
X-rays taken, dressing changed, sutures or staples are removed
A removable boot is applied, occasionally a cast
Start motion out of the boot as instructed
You can shower, provided the incision is clean and dry
30 lbs. of body weight is allowed 5 minutes twice a day when washing/bathing
Start in a swimming pool using a flipper to help movement of the ankle once completely healed and dry.
You can bear some weight in the pool if there is no discomfort or pain
At 4 weeks you may use a stationary bike, but with no pressure nor resistance on the ankle

6-8 weeks
Full weight-bearing in a boot. You should plan to walk as long as there is no pain in the ankle
Start physical therapy, and by 8 weeks you should start walking out of the boot if comfortable
Continue physical therapy, and increase activity according to instructions from your doctor
An orthotic arch support is important for your recovery. The orthotic support will be made in our clinic by specialist orthotist.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.
This is a fairly routine procedure with risk of:
Infection

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is rare, but if this does occur it will require the ankle prosthesis to be removed and antibiotic cover for about 6 weeks prior to considering a revision or a fusion operation. Overall risk is 1%.
Pins & needles or patch of numbness:
Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar or the top of the foot. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.
Clots – Deep vein thrombosis

Extremely rare in foot and ankle surgery (<5%). However you will be given blood thinning injections after surgery for 4 weeks to minimise this risk.

Loosening of the implant
This can occur and will manifest as ongoing pain or swelling. X-rays and a CT scan will be required to diagnose the area of loosening.

Recovery from surgery

What can I expect immediately after the surgery whilst in hospital?
When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot and a below knee back slab (which is half a plaster) applied. You will not be allowed to walk on the operated foot for atleast 6 weeks. The physiotherapists will make sure that you are safe on your feet before discharge and you will be provided crutches. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Post operative clinic visit schedule

2 weeks after surgery – wound check and advice regarding basic hygiene6 weeks after surgery – X-ray4s and advice regarding exercise
3 months after surgery – clinical exam and Xray
6 months – clinical exam and Xray

Annual check there after.

When can I begin to walk

You are not allowed to put weight on the operated leg for atleast 6 to 8 weeks.However you will be allowed to mobilise with crutches

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is 6 weeks after surgery.