Ankle replacement surgery involves removing damaged parts of the ankle joint and replacing them with an artificial joint. It is an option when noninvasive treatments, such as physical therapy, have been ineffective for arthritis.
Data suggest that total ankle replacement surgeries are usually successful. However, it does have risks, such as ongoing pain, infection, and nerve damage that can occur during the operation.
Keep reading to learn more about ankle replacement surgery, including who is eligible, success rates, the procedure, recovery time, and risks.
Ankle replacement surgery involves replacing damaged bone and cartilage in the ankle joint with an artificial joint, called a prosthesis.
The prosthesis has two metal parts. One part attaches to the lower end of the shin bone. The other part attaches to the talus, which is the bone at the top of the foot where the leg bones rest. A surgeon inserts plastic between the two metal parts and uses screws to stabilize the joint.
A person may be a good candidate for ankle replacement surgery if they have advanced arthritis and more conservative treatments, such as physical therapy and medications, have not worked.
This includes people with:
- primary osteoarthritis
- secondary osteoarthritis, which happens due to other conditions, such as infections or inflammation
- post-traumatic osteoarthritis, which happens after an injury
People
- acute or chronic infections
- severe damage to the talus
- significant ligament deformities or instabilities
- neuromuscular disease, which includes conditions that affect the nerves and muscles
- severe circulatory disorders
- neuropathies, or dysfunction of one or more nerves
- metal allergies
Diabetes, weakened bones, excess weight, and smoking can also reduce the chance of a good outcome, but they do not necessarily prevent a person from having an ankle replacement.
For people with many coexisting conditions, ankle fusion surgery may be a better alternative to ankle replacement. This involves fusing the talus to the tibia.
Total ankle replacements, or ankle arthroplasty, are usually effective. A 2023 review of past research suggests that the vast majority of ankle replacements are successful, with implants having a survivorship rate of 88.3% after 9 years. This means that a person did not need another surgery during that time to address any complications.
Of the surgeries examined in the review, 10.3% were not successful. However, 8.4% of those cases improved following additional surgery.
Before ankle replacement surgery, a doctor will talk a person through what will happen, including:
Preparation
For some, lifestyle changes may be necessary before the surgery. This can improve the outcome and reduce the risk of complications. A doctor may advise:
- stopping smoking
- reaching a moderate weight
- building strength with regular exercise
Surgery
When the procedure begins, a healthcare professional may administer general anesthesia or spinal anesthesia. General anesthesia causes a person to become unconscious, while spinal anesthesia does not.
When the person is completely unable to feel pain, the surgeon will begin making an incision at the front of the ankle.
The surgeon will remove the lowest part of the tibia and upper part of the talus bone, as well as any damaged cartilage. Then, they will attach the prosthesis, which consists of two metal or plastic plates.
They may make repairs to ligaments and other tissues around the joint, then close the muscle and the skin surrounding it. They will seal the wound with stitches, and a healthcare professional will dress it with bandages.
The surgery usually takes 1 hour to 90 minutes in total. Afterward, the healthcare team may place the leg into a boot, cast, or splint.
Aftercare
When the anesthesia wears off and the person is ready to go home, they will not be able to put weight on the ankle. They may use crutches, a walker, or a wheelchair to leave the hospital. Someone else will need to help them get home.
A doctor will advise on how a person can manage pain and swelling after surgery. This may include taking medications, using ice or elevating the leg to ease inflammation, and resting.
If they have an upset stomach from the anesthetic, a person may benefit from temporarily eating a bland diet. Staying hydrated can help with avoiding constipation, but if this occurs, a doctor may recommend a laxative.
A person may be able to shower after surgery if a doctor approves it. If they have a cast on the leg, however, they will need to keep it dry.
It can take time before a person can begin walking without mobility aids after a total ankle replacement. The timeline varies between people, but often involves the following:
First 2–4 weeks
The ankle may be painful and swollen after surgery. A person will need to keep wearing the boot, cast, or splint for around 6 weeks and avoid putting weight on the affected leg.
Generally, people will not be able to work during this time. Some may be able to return to work sooner, but this depends on the nature of the job. People who do physical labor may need to remain off work for several months.
If the stitches are not dissolvable, a doctor will remove them after 10–14 days. Otherwise, they will disappear on their own.
Long-term recovery
When a doctor approves it, a person can begin putting weight on the ankle. However, this needs to be gradual. The weight-bearing protocol the doctor sets will be different from case to case, as everyone has different needs. A person will also need physical therapy to rehabilitate the joint.
Once someone reaches the point of full-weight bearing, they may engage in low impact activities, such as:
- walking
- swimming
- golf
They may also participate in medium impact activities, such as skiing and tennis. However, they should avoid contact sports and activities that involve jumping.
As with all surgeries, ankle replacements have some risks. Temporary side effects of the procedure may include:
- pain and swelling
- constipation
- nausea or vomiting
- temporary memory loss
The surgery will also leave a scar on the ankle, and a person may not be able to participate in any high impact activities, such as running. Instead, they may have to only participate in low impact sports and exercises.
Potential complications of ankle replacement surgery can include:
- infection
- poor wound healing
- excessive bleeding
- allergic reactions to anesthesia or the prosthesis
- blood clots due to inactivity
- destruction of bone tissue
- nerve injuries
- fractures
- continued pain and mobility difficulties
In very rare cases, a person with severe complications may require amputation.
Prosthetic components can also deteriorate over time or break. If this occurs, a person will need further surgeries.
The following are answers to commonly asked questions about ankle replacement.
How painful is ankle replacement surgery?
The worst pain occurs just after the surgery, but pain medications may help with this. In time, as a person recovers, their pain should decrease. It should eventually be less than it was before surgery.
How much does ankle replacement surgery cost?
With Medicare, ankle replacement surgery costs $1,446 on average to the person undergoing the surgery. Without insurance, the surgery may cost much more. A
Can you drive after ankle replacement?
No, not for some time. A person will need someone to drive them home immediately after the surgery, and they will need to avoid driving until a doctor says they can put weight on the ankle.
Ankle replacement surgery involves replacing the ankle joint with a prosthesis. It is a treatment option for people with advanced ankle osteoarthritis. However, not everyone is an eligible candidate.
Ankle replacement is generally effective, but it does have some risks, such as continued pain or nerve injury. It also takes time to recover from ankle replacement.
For about 6 weeks following surgery, people will need to wear a cast or boot to stabilize the foot. They will also need mobility aids to move around. Afterward, they must begin physical therapy.