Total ankle arthroplasty: surgery

Surgical procedure for total ankle arthroplasty

The aim is to implant the three components of the ankle prosthesis into the joint.
An incision is done anteriorly on the ankle. Tendons, arteries and nerves are protected and retracted to allow joint exposure. Implants will be anchored into the tibia or talus bone; it is necessary to create the corresponding space. The bone cut has to be as economical as possible to preserve the bone stock. For this, the surgeon uses several successive instruments called “jigs” which will help the cutting but also the good positioning of the implants.
The ankle prosthesis is cementless. It is fixed into the bone by impaction, exactly as a nail in a wall. This provides the implants with an immediate stability so that a full weight-bearing is allowed immediately on the operated limb.

At the end of the procedure the ankle is placed in a removable boot cast. It aims to rest the skin and the tendons until wound healing, usually for 15 days.

Total ankle arthroplasty: postoperative X-ray just after implantation

Total ankle arthroplasty: postoperative X-ray just after implantation.

Postoperative course

The postoperative boot is removable so that the dressing is accessible. It is then changed every two days.
The ankle prosthesis is designed to allow an immediate full weight-bearing on the operated limb to restore as fast as possible the joint’s function. The boot and crutches helps the patient to regain confidence in his newly operated ankle.
Once the wound is healing, usually around the 15th day, the boot is no longer necessary and walking is allowed without crutches. A physiotherapy program is started in order to maintain the ankle’s motion and to helps recover a normal walking pattern.
Non weight-bearing sport (biking, swimming) are authorized after the 3rd postoperative month. It doesn’t constitute a surgical objective. If the patient it comfortable with it, he can progressively increase his activity level with his pain as a limit. It is of his interest to favor non weight-bearing sports instead of running sports. However, resuming sport after a total ankle arthroplasty is never guaranteed.
Finally, in the best case, the ankle is forgotten between 6 and 12 months after surgery.

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