Total Ankle Arthroplasty

Ankle replacement is a procedure to treat severe ankle arthritis that is gaining popularity. The methods to complete the procedure as well as the implants have gradually improved over the few years.

• Ankle replacement surgery has become a more common way to treat severe ankle arthritis
• Implant and surgical techniques have improved to optimize outcomes

Total ankle arthroplasty is a surgery where the arthritic bones around the ankle are resurfaced with metallic implants and a polyethylene bearing is placed between the metallic components. The goal of the surgery is to provide pain relief while maintaining some of the ankle range of motion.

Ankle replacement surgery involves removal of the arthritic surfaces in the ankle and replaced with a metallic implant sandwiching a polyethylene bearing.

Goals of the surgery

1. Maintain ankle range of motion
2. Reduce pain

Candidates for this procedure:

• Have severe ankle arthritis
• Have minimal deformity to the ankle (minimal coronal plane deformities)
• Have adequate bone stock to support the implant surfaces
• Have adequate ligamentous support around the ankle or can be adequately restored with ligament reconstruction
• Are middle age or older
• Are able to avoid high impact activities, such as jumping from a height, running, aggressive hiking, heavy lifting/twisting activities.
• Healthy skin around the ankle
• No neuropathy around the ankle

Dr. Flint currently performs the Restor3d Kinos Axiom Total Ankle arthroplasty. (Total Ankle Replacement | restor3d) This latest generation total ankle device has a three dimensional printed bony ingrowth surface to more completely facilitate osseointegration. This allows the bone to grow into the metal surface on the implant to prevent loosening of the implant which is a common failure mode of many ankle replacement implants. The device also uses Vitamin E infused, ultra-high molecular weight polyethylene bearings that reduce wear by trapping free radicals that oxidize bearing and lead to premature wear.

Patients who elect for this surgery undergo a CT scan of the leg. The CT scan is then sent to the manufacturer who then using segmentation software, creates a surgical plan. Dr. Flint meets with the representatives from Restor3d and finalizes the surgical plan. Using the planning software, deformities can be corrected and imperfections in the bone can be identified. Custom three-dimensional cutting blocks are then manufactured and used for the surgery.

The procedure takes about 2 hours to complete. Patients are typically discharged the same day or the day after the procedure from the hospital. Dr. Flint typically performs these procedures at St. Luke's Meridian Medical Center in Meridian, ID or St. Luke's Center for Orthopedic Medicine in Boise, ID. The anesthesia teams at these facilities will typically perform a nerve block on the leg to minimize pain during and after the surgery. Long acting medications such as Exparel in many cases are used to reduce the pain over several days.

After the procedure, patients are non weight bearing for six weeks. The ankle is casted for the first 3-6 weeks following surgery. If the skin incision is healthy at three weeks following the procedure, the patient is allowed to begin early range of motion. Sutures are removed at three weeks following surgery. Patients typically start physical therapy at six weeks after surgery.

Following surgery

• May be performed as an outpatient or short stay
• Six weeks non weight bearing
• Sutures are removed at three weeks
• Physical therapy starts at six weeks after surgery
• Full recovery takes one year, but most return to normal activities 9-12 weeks following surgery

Total ankle arthroplasty patients enjoy less pain at their ankle and also regain a higher level of function. Satisfaction with this procedure is higher than other typical procedures for severe ankle arthritis.

If you or a loved one are suffering from ankle arthritis, please feel free to contact our office. We would love to discuss options with you and answer your questions.