“Should I have surgery to replace my painful ankle?” a friend recently asked me. He added, “I now wear an ankle support to play tennis, and I want to get rid of it.”
Today, we all know friends who have had surgery to replace a worn-out hip or knee, but an increasing number of people are also getting new ankles. What should my friend and others know before they make this decision?
The majority of ankle replacements are due to osteoarthritis, the wear-and-tear type that occurs with aging, but an arthritic ankle can also develop following injury to the joint many years earlier. Cartilage between bones deteriorates, and finally bones grind on bones.
Replacing an ankle is not minor surgery. Surgeons can’t simply make an incision and snap a metal device in place. Rather, the new metal ankle joint must be firmly attached to two major bones—the tibia in the lower leg and the talus bone of the ankle—to hold the implant firmly in place.
During the procedure, surgeons have to sever the lower ends of the tibia and talus to remove worn-out parts of these bones. Amputating the lower end of these bones also provides a level surface. Then one end of the new ankle is inserted into the tibia and the other end into the talus bone.
Who is a good candidate for ankle replacement surgery? First, those considering this operation have to realize that artificial ankles are never as good as the ones they had at 18 years of age. Rather, the prosthesis is designed to withstand the weight of the body and the repetitive motions of walking. But there is a limit to the amount of stress it can endure if repeatedly pushed to the limit. So a new ankle is usually recommended for those whose only wish is simply to walk again without pain.
But it is not advised for younger patients who are more active and want to play tennis and other high-impact sports causing high amounts of stress on the joint. Nor is it advised for those engaged in heavy labor.
Patients who are obese are poor candidates, as the joint will not withstand their weight over time. Good healing also requires good circulation, so patients with diabetes who have increased amounts of atherosclerosis are normally not suitable for ankle replacement.
Patients having an ankle replacement don’t walk into the hospital one day and return to normal activity the next day. Pressure on the ankle replacement must be limited for several weeks, so the use of a walker or crutches is necessary for several weeks. Complete recovery takes about three months.
Don’t forget the possibility of surgical complication when considering ankle replacement. There’s always the chance of infection when opening up a joint.
Ankle replacement also only lasts for a limited period of time. At the moment the life-span of an ankle prosthesis is about 10 years. This means facing the prospect of another operation down the road.
Although a new joint fits perfectly following surgery, there’s also the risk that it may loosen over time, causing renewed problems.
So what did I advise my friend? I told him what I tell all surgical patients, that they must first determine how much the problem is affecting their quality of life. If it’s a minimal inconvenience, it’s prudent to live with the devil they know than the devil they don’t know. For some elderly patients, this may mean giving up a favorite sport rather than facing the risk of major reconstructive surgery.
I’ve received too many letters and e-mails over the years that say, “If I had known before the surgery that this would happen, I would not have had it done.” To decrease this risk, always be sure to ask your surgeon, “What are the worst complications that can happen to me?” This will cut down the number of surprises following an operation.
If my friend does decide on surgery, he should go to a first-rate hospital and have a first-rate surgeon perform the operation. The safest way to go to surgery is always on a first-class ticket.
Dr. Gifford-Jones is a medical journalist with a private medical practice in Toronto. His Web site is Mydoctor.ca/gifford-jones
