What is ankle replacement?

Ankle replacement removes a damaged ankle joint and replaces it with an artificial joint called a prosthesis. Your surgeon may recommend this surgery if your ankle is severely damaged by arthritis, injury or infection. Ankle replacement is also called ankle arthroplasty or ankle joint replacement. It can restore pain-free range of motion and ankle function.

Your ankle contains three bones – the lower end of the shinbone (tibia), the lower end of the smaller lower leg bone (fibula), and the anklebone (talus). The talus sits on top of your heel bone (calcaneus). The ankle is a complex joint that also contains ligaments, tendons and cartilage. It hinges to allow foot movement, helps support your body weight, and supports movements in your toes and calves. Your ankle lets you walk, run, jump, and raise your toes.

Ankle replacement is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having ankle replacement. 

Why is ankle replacement performed? 

Your doctor may recommend ankle replacement to treat serious ankle damage when symptoms are severe or restrictive. This includes severe pain, deformity or disability, including difficulty walking. 

Ankle replacement is not a common surgery and is not the first choice to treat ankle problems. Your doctor will only consider ankle replacement if less invasive treatments do not improve your pain and ankle function. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend ankle replacement to treat severe or permanent ankle joint damage due to: 

  • Ankle joint infection, also called septic arthritis
  • Ankle joint injuries, including fractures, torn ligaments, and torn cartilage 
  • Inflammatory forms of arthritis, including rheumatoid arthritis
  • Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones 

Who performs ankle replacement?

Orthopedic surgeons and foot and ankle surgeons perform ankle replacement. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Foot and ankle surgeons are orthopedic surgeons or podiatrists who further specialize in surgery of the foot, ankle, and lower leg. 

How is ankle replacement performed?

Your surgeon will perform your ankle replacement in a hospital. It involves making an incision in the front of the ankle to remove the damaged bones. This includes the ends of the lower leg bones and the top of the anklebone (talus). Your surgeon shapes and prepares the remaining bone to hold the new joint. Your surgeon then places an artificial ankle joint made of metal and plastic, tests the new joint, and secures it permanently in place.

Types of anesthesia 

Your surgeon will perform your ankle replacement using either general anesthesia or regional anesthesia. 

General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. 

What to expect the day of your ankle replacement

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.