From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Ankle replacement surgery is treats ankle arthritis. Here, the worn out joint surface is removed and a metal and plastic implant is placed to function as a new joint. Ankle replacement surgery is very similar to other joint replacements commonly performed in the knee and hip joints.

Who is a good candidate for ankle replacement surgery?
Ankle replacements are generally recommended in older, less active patients. Patients should not perform activities that would place high demands on the implant joint, such as impact sports or heavy labor.

Ankle replacement is also considered in patients who have arthritis in the joints of the foot as well as the ankle joint. Because a fusion procedure places more of a burden on the surrounding joints, the ankle replacement may relieve the stress on the joints of the foot.

Who is not a good candidate for ankle replacement surgery?
Younger patients tend to be too active for current ankle replacement implants, and place too much of a demand on the ankle replacement prosthesis. Therefore, most patients under 50 years of age will have ankle fusion surgery. In patients over 50 years old, ankle fusion will still be offered to those who are more active and place more demands on the joint.

Patients who are overweight should generally avoid the ankle replacement procedure. Obesity also increases the burden on the implanted joint, and can lead to problems. Other patients who should avoid ankle replacement include patients with ankle infections, patients with poor blood flow to the feet (peripheral vascular disease), and patients with severely abnormal alignment or stability of the ankle.

How is ankle replacement surgery performed?
When an ankle replacement is performed, the worn out joint surfaces of the end of the shin bone (tibia) and top of the ankle bone (talus) are removed. This is performed with precise instruments to create a level surface for the implanted prosthesis. The surgeon then places a metal and plastic implant into the bone ends to function as a new ankle joint.

What is the recovery from ankle replacement surgery?
Patients undergoing ankle replacement generally spend one night in the hospital after surgery. Pressure on the ankle replacement must be limited with the use of a walker or crutches for several weeks. Complete recovery from an ankle replacement takes about three months.

What are the possible complications from ankle replacement surgery?
Complications of ankle replacement include infections, would healing problems, and persistent pain in the ankle joint. Achieving satisfactory alignment of the implants to allow for normal walking is difficult, and cannot always be achieved. If the ankle replacement does not work, it may need to be removed from the joint, and an ankle fusion surgery would then be performed.

Is ankle fusion or ankle replacement a better surgery?
Unfortunately, no one knows the answer to this question, and it probably depends on the individual patient. No study has compared the long-term results of these two procedures in a way that lets us determine which procedure is better.

Certainly as total ankle replacement implants have become better designed, and as the surgical techniques have improved, the results are more promising. However, the ankle fusion surgery is still considered the standard surgical treatment for advanced ankle arthritis.

_Sources:

• Easley, ME, et al. "Total Ankle Arthroplasty" J. Am. Acad. Ortho. Surg., May/June 2002; 10: 157 - 167.