What is Ankle Arthroplasty?
Ankle arthroplasty is a modification procedure to the ankle joint where, joint is replaced with artificial prostheses.
When we refer to the ankle joint, it is made of 3 bones, which are the distal ends of the tibia and fibula and also the talus. The joint which is replaced is the tibiotalar joint. The joints are separated by a lining of cartilage, which is referred to as the articular cartilage.
The wear and tear of the articular cartilage or inflammation causes destruction of the joint resulting in ankle disease. Ankle arthroplasty is a magnificent innovation in the field of surgery.
Why would you need ankle arthroplasty?
Degenerative changes or inflammation of the ankle joint can decrease the range of movements and cause immense pain to the patient, making it a disturbing situation, reducing the overall quality of life.
The two most common causes of ankle arthritis are:
- Rheumatoid arthritis of the ankle: There is stiffness of the joints with marked destruction of the articular cartilage, and the bone underlying the cartilage, resulting in pain and deformity.
- Osteoarthritis of the ankle: Degeneration of the articular cartilage in the ankle joint due to osteoarthritis is more common in the hip and knee than due to the ankle joint.
What are the symptoms and signs of ankle disease?
The symptomatic manifestations in ankle diseases are mostly due to rheumatoid arthritis and osteoarthritis and may be worth being discussed individually.
The symptoms and signs associated with rheumatoid arthritis affecting the ankle joints are:
- Severe ankle pain with early morning stiffness of the joints and decrease in the range of movements, and deformity of the joint.
- Xrays show loss of joint space and erosion of the articular cartilages of the tibiotalar joint
- Blood investigations may show a high level of rheumatoid factor and anti- cyclic citrullinated peptide (anti-CCP)
- Some people even present with anaemia of joint disease due to chronic inflammatory process.
The symptoms and signs associated with osteoarthritis affecting the ankle joints are:
- There is always a known predisposing factor which causes the ankle joint to wear out prematurely, most commonly due to a fracture of the ankle joint causing malalignment of the joint surfaces leading to joint effusions, inflammations and bony spur formations. These can eventually, lead to joint space narrowing and subchondral sclerosis.
- The symptoms are almost similar as in any arthritis with pain and joint stiffness and decreased range of movements, which increases over months to year, making the patient to limp.
- On examination, the joints are swollen, warm, tender and red. There may be bony spurs (osteophytes) at the joint margins visible on an Xray and we may see a joint space narrowing, with subchondral cysts and sclerosis.
- More often, there is a co-existence of osteoarthritis with rheumatoid arthritis, where joint destruction occurring due to rheumatoid disease can serve as an initiating factor for the osteoarthritis to develop.
- On blood investigations, the inflammatory markers of joint disease may be elevated, like erythrocyte sedimentation factor (ESR) or C-reactive protein (CRP)
For further references, kindly follow our link on joint replacement surgeries for an overview.
Why are these diseases affecting your ankle joints?
In Rheumatoid arthritis, there is an autoimmune inflammation of the joints due to production of autoantibodies like anti cyclic citrullinated peptide (anti-CCP) and rheumatoid factor, which can cause destruction of the joint articular cartilages, leading to the wide range of symptoms. It usually affects the small joints of the hands and the feet with early morning stiffness. However, it can also involve the larger joints as it is a systemic disease.
However, in osteoarthritis, it is an inevitable part of ageing in the larger joints like the knee and hip joints. But as part of secondary inflammation from rheumatoid arthritis or fractures or osteochondromatosis, there can be a significant damage to the ankle joints from osteoarthritis. The friction at the joints and the strain at the joint surfaces contribute to osteoarthritis in general.
Whichever, be the cause for the ankle joint injury, joint replacement can serve as a permanent cure to the problem.
How is ankle arthroplasty done?
The prosthesis placement surgery of the ankle or ankle replacement surgery is a quite common surgery done nowadays and the steps involved are as follows:
- Patient assessment is done by taking a history and joint examination, followed by Xrays and a panel of blood tests to assess the cause for the arthritis
- Once it is decided by your surgeon that, you will be benefitted by ankle arthroplasty we will send you for the pre-anaesthetic fitness to the anaesthesia clinic. They may run any extra investigations to see if you are fit for anesthesia.
- When anaesthetic fitness is cleared, we will see you again and decide on a date for the surgery.
- You might have to get admitted in the hospital a day before in order to make arrangements and preparations required for the surgery, including medication changes and ensuring nil by mouth since the morning of surgery. Moreover, it helps in discussing the consent for surgery as well, by discussing the merits and demerits of undergoing the surgery.
- Based on the operation theatre schedule, we will shift you to the theatre, where your anaesthetist and orthopaedician will see you.
- The anaesthetist will ask you a couple of questions and ensure the patients identity and profile and take you into the theatre for induction of anaesthesia.
- Once anaesthesia is given, the surgeon will operate on you, by an anterior approach which opens the front part of the ankle joint.
- This exposes the ankle joint, and the lower portions of the tibia and the upper portions of the talus, which together forms the tibiotalar joint, is removed.
- A prosthetic joint is then placed in its position, so that the inflammatory segment is removed completely.
- This enables normal range of movements at the ankle joint, and once the prosthetic joint is placed, the surgeon ensures that it is working properly and closes the skin by sutures.
- Once the surgery is over, you will be shifted out to the post operative recovery room once you are brought back from anaesthesia.
- After ensuring that it is safe to shift you out to the room, we shift you to your room or ward and the orthopaedician will see you during the ward rounds.
- Early mobilisation is the key to ensure that the functioning of the joint is assured and also to prevent any complications like deep vein thrombosis. However, necessary precautions are taken so that a venous thrombosis is avoided.
- It may involve the help of physiotherapists and support nurses to make you feel comfortable with your improved range of movements
- Once we are sure that you can be discharged to continue with your daily activities, we send you home with any medications including anti-inflammatory medicines or antibiotics if necessary.
- In case you are suffering from diseases like rheumatoid arthritis, we will consult you with a rheumatologist to make sure that your medicines for rheumatoid disease are also adjusted simultaneously before discharge.
- We will review you in a few days for suture removal and to see how well you are doing, to ensure that everything has been going very well with you.
Am I a Good Candidate for ankle arthroplasty?
Well, if you are a person who is suffering from unbearable ankle pain which affects your quality of life, and if the pain hinders your day to day activities from being in its best possible ways, then ankle arthroplasty is the best choice for you.
Ankle arthroplasty is moreover a permanent cure to the joint problem, because the joint as such is replaced and decreases the chances of wear and tear in future.
What are the advantages of doing an ankle arthroplasty?
The benefits of ankle arthroplasty are:
- Permanent solution to your joint problem and improvement in your range of movements at the ankle
- No more painful nights or days. It can help in halting the progression of the arthritis and prevent painful episodes
- Stiffness of the joints are sorted , and now the joint moves on an artificial prosthesis
- The quality of life is improved altogether after the surgery
Why Choose MedcureIndia?
Our orthopaedic team is one among the best in the country with efficient surgeons performing arthroplastic procedures almost every day.
We at MedcureIndia, ensure the patient safety and satisfaction to make them active enough run rather than walk, when they come to see us in a crippled state. We have lots of successful stories to add with, in order to explain our achievements to our clients.
Join us today and benefit yourselves.