Arthroplasty is a total joint replacement of a joint with a metal, medical-grade plastic or ceramic device called a prosthesis. Total ankle arthroplasty (TAA), is a surgical procedure that is performed when all other treatment options have failed. TAA can be another option other than an ankle fusion to help relieve pain and give similar motion in the joint compared to the loss of motion with an ankle fusion. TAA is not recommended for those that have inadequate bone to support the implants, prior deep infection of the ankle joint, or a neuromuscular disease that can impair the muscles that results in decreased muscle tone and function.
Pre-Treatment
Your physician will recommend this procedure depending on your condition, age, weight, and activity level.
Ideal candidates for TAA have maintained good ankle range of motion and a minimal to no ankle deformity.
Procedure
General anesthesia is generally used as well as a nerve block
Your surgeon will start by removing the arthritic cartilage and both sides of the ankle joint.
Next they will replace the joint with a prosthesis (medical-grade plastic with a titanium base plate and the talus is replaced by a cobalt chromium alloy prosthesis).
Once the replacement is complete and works well the surgeon will close the incisions with sutures or staples and then the ankle is put in a splint.
Post-Treatment
After surgery, if done in a hospital, you may be kept for a night or two. If it is done as an outpatient procedure you will be able to go home after.
You will be given at home care instructions this may include:
Ankle elevation requirements for the next couple of days to help reduce swelling and allow wound healing.
Expect to be nonweightbearing in a splint or cast for 3-4 weeks.
Then for the next 3-4 weeks you can usually begin to bear weight as tolerated.
Typically after 6 weeks you will be able to return to a regular shoe and begin physical therapy.
Early weight bearing and range of motion is not recommended for a TAA as there is concern since the skin is so thin around the ankle that the tendon that lies under the incision will glide back and forth causing friction that could cause wound healing problems.
After recovery patients can normally return to low impact activites
Pros
The goal of TAA is to provide pain relief and range of motion in the joint.
Provide better movement and coordination of the foot and leg
Improved quality of life
Less stress on the surrounding joint because of the maintained ankle range of motion.
TAA device can last 10 years or more
Cons
Plastic components between the metal device can wear out.
May need revision surgery
May need another total ankle replacement or ankle fusion after 10 years.
Complications
Blood clots
Infection
Excessive blood loss
Complications with anesthesia
Fracture on either side of the prosthesis
Wound healing problems
Implant failure (If bone fails to heal to the metal components)
Revision surgery
