Complete degeneration of the cartilage with associated development of arthrosis results in increasing stiffening and deformity of the ankle joint. Bony spurs (osteophytes) form, which sometimes can be palpated from the outside. At the same time, pains occurs, initially associated with with stress and movement, later also at night and at rest, resulting in an increasing limitation of the walking range and ultimately in a reduction in quality of life.
The arthrosis can be shown in the normal X-ray image; the narrowing of the joint cavity between the tibia and the talus can be seen as an indirect indication of the loss of cartilage. The surfaces of the joint are often destroyed and no longer fit together well ("running on the rim").
If conserving the joint is not an option for technical reasons or because of the age of the patient and all other conservative and surgical options (debridement, cartilage-bone transplant, etc.) have been exhausted, a total ankle joint replacement is carried out. In cases of symptomatic arthrosis of the ankle joint, replacing the ankle joint with a prosthesis is increasingly an alternative to stiffening the joint (arthrodesis). The implants, which have been continuously improved since the 1990s and these days are generally cement-free, permit and retain mobility in the ankle joint with noticeably reduced rehabilitation periods, thus reducing excessive strain on neighbouring joints.
The primary aim of the operation is to achieve freedom from pain and improved mobility. Advances in surgical techniques and implants over recent decades make this a successful procedure in the hand of an experienced foot surgeon, as confirmed by our own experience over long periods of time.
Prostheses as currently used consist of three parts:
- the anatomically shaped talus head
- the tibial section, press-fitted with exact pins or screwed in
- a semilunar plastic sliding core between talus and tibia permitting movement on several planes.
Model of an artificial ankle prosthesis (S=tibial section, G=sliding core, T=talus head)
Diagram of an ankle prosthesis connected to the bone
After your operation
The following are general guidelines:
Elevate. Rest until wound is completely healed (5-10 days). Cool the joint repeatedly with a dry ice-pack (for about 15 minutes). As soon as pain and swelling permit, increase your mobility. Immobilization is generally not required!
Medication
Anti-inflammatory and analgesic tablets (diclofenac or paracetamol) prevent inflammation and control pain.
Recommended dosage: 3 x 1 tablet per day for 7-14 days
Anti-thrombotic injections (e.g. Fragmin) to prevent thromboses are to be administered for at least as long as you use crutches to ease the load on your foot.
Aftercare
Stitches are generally removed after about 12- 14 days. If the wound is healing without irritation and swelling has reduced - generally on day two or three after the operation - a special stabilisation aid (Vacoped brace) is fitted which permits the normal walking movement of the ankle joint with increasing weight-bearing, but prevents sideways slippage. Wearing this brace, active and passive mobilization of the joint with partial weight-bearing begins. Functional treatment without the brace begins in or after week 5 following the operation, involving gait training and exercises to stretch and strengthen the calf muscles. Only a few weeks after the operation, largely pain-free walking with full weight-bearing should be possible. This permits a speedy resumption of normal daily activities.
Stiffening of the ankle joint (arthrodesis) is a sensible alternative only in cases of severe non-correctable malalignments combined with arthroses of the ankle joint.