Ankle Replacement

Learn more about ankle replacement surgery at King Edward VII’s Hospital

We know living with a damaged ankle can be a painful experience and can stop you doing the things you love.  Here you can find out more about our London ankle replacement specialists and find out if this treatment is the right option for you. On this page King Edward VII’s Hospital London ankle replacement consultants answer your questions about the procedure.

Why would I need ankle replacement surgery?

If you have arthritis in your ankle joint that’s affecting your mobility and quality of life, you may benefit from having an ankle replacement.

There are two forms of arthritis, osteoarthritis and rheumatoid arthritis. Osteoarthritis causes a gradual wearing down of the ankle joint. Rheumatoid arthritis causes the ankle joint to become inflamed, leading to the wearing away of the cartilage that protects the bone, causing damage to the ankle bones. Both can cause considerable pain, discomfort, swelling and stiffness and can lead to a situation where an ankle replacement is your best option.

What symptoms does ankle replacement surgery address?

Most people who have an ankle replacement find that the arthritis pain and discomfort they previously experienced has improved.

When should you speak to your specialist about ankle replacement surgery?

If pain relief, physiotherapy, special shoe insoles or using a walking stick doesn’t help your ankle discomfort and it’s affecting the way you live your life, then speak to an ankle replacement specialist who can discuss an ankle replacement with you.

How is ankle replacement surgery performed?

Ankle replacement surgery is performed under a general anaesthetic, along with a popliteal block, which numbs the leg below the knee for 24-72 hours. This helps decrease post-operative pain and decrease opiate use. The procedure usually takes approximately 2 hours.

This type of surgery usually requires your ankle replacement consultant surgeon to make an incision in the front of the ankle. The worn, damaged or inflamed surfaces of the ankle joint are surgically removed and replaced with prosthetics.

The prosthetic ankle joint is designed to move feely like a normal ankle joint and over time will bond with the natural bone. The incision is then stitched together and the ankle and lower leg bandaged and placed in a plaster cast.

What is the recovery like for ankle replacement surgery?

Your recovery from ankle replacement surgery will depend on multiple factors, including your age, fitness level and the nature of your procedure. Most patients stay in hospital for 2-4 days following an ankle replacement. Your length of stay will be dependent on your ability to safely and independently mobilise using crutches.

The nursing team will show you how to bath, dress and self-care. The physiotherapy and occupational therapy team will help you when you first start walking, to make sure you keep the weight off your ankle. They will ensure that you will be able to cope at home.

Once you’re able to get up on your own and move around using crutches, you will be allowed home.

You shouldn’t put any weight on your ankle for at least the first 2 weeks to allow the bones to heal. Your surgeon will tell you exactly how long you should rest your ankle for.

For the first few weeks, you will need to keep your leg elevated as much as possible to reduce the risk of swelling.

After around two weeks, you will be seen by your surgeon to check your healing. You will then be given a new plaster cast or Aircast boot and your physiotherapy team will help you to begin walking with your weight gently on your ankle, still using crutches.

At around six weeks post-surgery, your cast or Aircast boot will be removed and you may be able to walk without crutches, but your medical team will advise you. You will continue with physiotherapy. Your surgical team will also advise you how long you can expect to be off work and need to refrain from driving and sports activities.

It may take up to 8 weeks before you can fully resume your day-to-day activities.

Are there any risks/complications associated with ankle replacement surgery?

As with any medical procedure, it’s possible for risks or complications to arise. Speaking with your specialist or surgeon beforehand will help you avoid any adverse reactions.

Ankle replacement surgery has a relatively low risk of serious complications, but the following risks and complications can occur in a small number of cases:

• Swelling – can still be there 6-9 months post-surgery
• Nerve or blood vessel damage
• Numbness in the ankle
• Infection in the wound
• Blood clots leading to deep vein thrombosis (DVT)
• Bleeding within the joint
• Fracture or failure of the new joint
• Wear of the prosthesis
• Dislocation
• Slow wound healing
• Ongoing, but less severe, pain

How can I prepare for ankle replacement surgery?

Prior to ankle replacement surgery, your surgeon will discuss with you how best to prepare for surgery, as each patient is different.

Common preparations for ankle replacement surgery include:

• Routine blood tests, x rays or scans as requested by your surgeon
• Taking steps to stop smoking if you smoke
• Losing weight if you’re overweight
• Remaining active and doing regular exercise

Are there alternatives for ankle replacement surgery?

If the wear and tear or inflammation in your ankle is severe, leading to severe pain, if your foot is severely deformed or your ankle is very unstable, then you may not be suitable for an ankle replacement.

In these circumstances, your surgeon will discuss a different surgical procedure called an ankle fusion to fuse the bones together instead.