Total Ankle Replacement: All Your Questions Answered

A total ankle replacement (total ankle arthroplasty) is surgery to treat arthritis or other issues of the ankle joint. It works to restore your mobility and eliminate pain by replacing damaged or diseased bone and tissue and replacing them with prosthetic implants.

Board-certified surgeons, Ryan N. Lawrence, DPM, and Joe T. Southerland, DPM, at Arlington/Mansfield Foot & Ankle Centers in Arlington and Mansfield, Texas, know our patients considering a total ankle replacement have many questions about the procedure and what to expect. 

Keep reading as we answer all your total ankle replacement questions!

What conditions can a total ankle replacement (TAR) help?

Healthy people with arthritis in their ankle and little or no misalignment or deformity of the joint are typically the best candidates. We recommend this surgery for patients hoping to return to an active lifestyle.

TAR may also be a good option for patients with an ankle injury that isn’t treatable using other methods or hasn’t improved with more conservative treatments, including:

• Bone fracture
• Infection
• Osteonecrosis (bone disease)
• Tumors 

At Arlington/Mansfield Foot & Ankle Centers, we take a conservative approach to TAR surgery. Our team explores less invasive options first. 

Who should not get a total ankle replacement?

Ankle replacement surgery is not the right treatment for every ankle condition. Our providers may recommend other therapies if you:

• Have unstable or deformed ankles
• Have a bone infection or history of joint infection
• Have a circulatory system condition
• Are a diabetic or have nerve issues

It’s important to keep in mind that TARs function optimally in patients who are at a healthy weight. Your Arlington/Mansfield Foot & Ankle Centers provider may caution against a TAR if you are obese.

What happens during TAR surgery?

During a TAR surgery, you’re kept comfortable and pain-free using a general anesthetic. For patients who can’t undergo general anesthesia, our providers may use spinal anesthesia. This numbs you below the waist so you won’t feel anything.

Your surgeon then makes an incision and removes all damaged and diseased tissue and bone. Once only healthy tissue remains, your provider attaches the prosthesis to the bone. 

Biocompatible screws may keep the prosthesis in place and make sure your new joint is stable. The incision is then closed, and you’re sent to recovery. 

Are there risks associated with TAR?

Like all surgical procedures, TARs have associated risks. These risks come from both the surgery and anesthesia and the replacement and include:

• Allergies to medications/anesthesia
• Breathing issues
• Bleeding or clotting problems
• Infection 
• Blood vessel damage
• Ankle stiffness, instability, or weakness
• Issues healing after surgery
• Bone fractures during surgery

It’s also possible to dislocate the new joint after surgery. In rare cases, you may have an allergic reaction to the prosthetic joint. 

What’s recovery like after TAR?

You can expect discomfort as your body heals in the weeks following your TAR. Recovering from TAR takes time. You’ll need to engage in physical therapy and follow all precautions from your surgeon. 

The exact time to recover depends on many factors, including your fitness and overall health before your surgery. On average, most patients recover in 6-12 months. Once you’re fully recovered, you can expect to move without experiencing pain or discomfort.

You can expect to return to normal daily activities and low-impact exercises, like swimming, cycling, golf, and walking, with no issue. Most of the time, it’s best to avoid high-impact exercises, like jumping or running, and any sports that may damage your new joint. Your provider gives you guidance about which activities you can safely engage in. 

How long will my TAR last?

The answer to this question depends on many factors, including your age and overall health before the surgery. Studies tell us the following:

• 90% of TARs are functional and din place 5 years post surgery
• 80% of TARs are function and in place 8 years post surgery

Keep in mind that few long-term studies exist past 10 years post surgery. This is because the technology for today’s TARs is relatively new. 

You may need a replacement or revision 10-15 years after the initial surgery. Your provider can give you more detailed information. 

Are there alternatives to TAR?

Ankle fusion can also ease ankle pain and restore some mobility, though it’s generally better for patients with end-stage arthritis. This procedure involves fusing together the bones that make up your ankle joint and is generally recommended when total ankle replacement isn’t an option since it limits your range of motion. 

To get personalized answers to your total ankle replacement questions, schedule an appointment online or over the phone at the Arlington/Mansfield Foot & Ankle Centers office nearest you.