In a healthy ankle joint, cartilage cushions and protects the bones that make up the ankle and absorbs the shock of daily wear. Cartilage can break down due to age, wear, disease, or injury. The body cannot reverse cartilage loss. When the cartilage loss becomes severe, the bones in the joint grind against each other. This bone-on-bone contact causes pain and limits activity. Your physician may refer to this as “end-stage ankle arthritis pain.”
The human ankle is a joint that acts much like a hinge. The lower end of the tibia, often called the shinbone, and the fibula, the small bone of the lower leg, create a socket. The foot bone called the talus fits inside the socket. The bottom of the talus sits on the heel bone, called the calcaneus.
A healthy ankle is a very flexible, free-moving joint. It can move up and down, side to side, and twist. To function fully, the ankle joint depends on the successful coordination of many interrelated parts. These include bones, muscles, tendons, ligaments, cartilage, and nerves.
To diagnose the root cause of your ankle pain, your physician will conduct a physical exam. You can also expect questions about your pain, activities, and medical history. Depending on the findings, your physician may request imaging tests and lab work.
Imaging tests may include an X-ray. This will show your physician the space between the bones, bony growths, and any fractures. A computerized tomography (CT) scan or bone scan may be used to identify fractures not visible on X-ray. Your physician may request magnetic resonance imaging (MRI) to visualize the bones and soft tissues.
Lab tests may include a blood and/or joint fluid sample. Test results may provide important clues that could indicate arthritis or another inflammatory disease.
If you have post-traumatic / end-stage ankle arthritis, you may experience chronic:
The most common causes of post-traumatic / end-stage ankle arthritis are:
Osteoarthritis (OA) is the most common joint disorder. It’s also called “degenerative arthritis.” OA is the result of aging and joint wear. According to the Center for Disease Control (CDC), 30 million Americans have OA.
Rheumatoid arthritis (RA) is less common. It occurs when the body’s own immune system attacks the joint’s soft tissue. This produces inflammation, swelling, and pain.
In the case of post-traumatic arthritis, an ankle injury causes trauma to the joint. The trauma could be a single damaging event such as an accident. Or it could be a series of smaller, repeated injuries such as the strains and sprains endured over years of running. The injuries damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The time between the original trauma and the onset of post-traumatic arthritis may span months or years. For example, an ankle sprain during childhood or adolescence that you thought was healed may develop into post-traumatic arthritis years later.
For most physicians, the first line of treatment for chronic, severe ankle arthritis pain is nonsurgical. Treatment often includes limiting activities that may irritate your ankle joint. Your physician may also recommend shoe inserts (orthotics), an ankle brace, or a cane. Another option is a custom-made shoe with a stiff sole and a rocker bottom called an ankle-foot orthosis (AFO).
Medications may also be part of your treatment. Nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen may reduce inflammation and pain. Injections, such as cortisone, may also provide pain relief.
When non-surgical treatments fail to provide relief from chronic, severe ankle arthritis pain, it’s time to consider surgery. Ankle fusion eliminates the joint to relieve pain, but it also has disadvantages:
With Total Ankle Replacement, “arthroplasty,” the physician replaces the damaged joint with an implant. The new, artificial joint can relieve pain and closely mimic the natural movement of a healthy ankle. Unlike patients with ankle fusions, patients with Total Ankle Replacement typically are able to walk pain-free with a normal gait within a year of surgery.
In recent years, an increasing number of ankle specialists are beginning to adopt and recommend ankle replacements rather than fusions.
As ankle replacements become more common, researchers are able to compare outcomes for patients with ankle fusions to those with ankle replacements.
These studies reveal:
1. Soohoo, “Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty” – Journal of Bone & Joint Surgery
2. A lower level of patient satisfaction among ankle fusions patients compared to ankle replacement patients
3. Soohoo, “Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty” – Journal of Bone & Joint Surgery
During ankle replacement surgery, the physician covers the tibia with a metal tibial tray. Next, a metal talar dome covers the talus. A plastic liner placed between the tray and the dome enables the hinge-like motion of a healthy ankle. Typically, no additional hardware is required for fixation.
The number of ankle replacement surgeries, and who performs them, continues to grow. More and more foot and ankle physicians are utilizing total ankle replacement confidently to alleviate their patient’s pain and to restore mobility. If your physician isn’t familiar with Total Ankle Replacement, use our physician locator to find a physician who is.
Yes, ankle replacement surgery is covered by most private insurance companies as well as Medicare and Medicaid. You may work with your doctor’s office staff to determine specific coverage for this procedure based upon your specific insurance plan.
If you are not a good candidate for an ankle replacement, your physician may recommend ankle fusion. During ankle fusion surgery, the physician prepares the bones’ surfaces and joints. Then the physician secures them together using plates, screws, or external fixation. The physician typically adds a bone graft (harvested from the patient’s hip or leg) or synthetic graft to promote bone regrowth. After the bones have fused together, the hardware may be removed.
There are risks associated with harvesting a bone graft. That’s why Wright Medical developed AUGMENT® Bone Graft. It is the first and only synthetic bone grafting material approved for foot and ankle fusions by the FDA. In the largest foot and ankle clinical trial ever conducted, AUGMENT® Bone Graft performed comparably to using the patient’s own bone as a graft. More importantly, AUGMENT® Bone Graft eliminates the costs and the risks that come with an additional surgical procedure to harvest bone. Learn more about AUGMENT® Bone Graft.
DiGiovanni CW, et al. Recombinant Human Platelet-Derived Growth Factor-BB and Beta-Tricalcium Phosphate (rhPDGF-BB/β-TCP): An Alternative to Autogenous Bone Graft. J Bone Joint Surg Am. 2013 Jul
DiGiovanni CW, Lin S, Pinzur M. Recombinant human PDGF-BB in foot and ankle fusion. Expert Rev Med Devices. 2012 Mar; 9(2):111-22.
FDA did not base its approval of AUGMENT® Bone Graft on radiologic findings from the pivotal study, but instead relied on clinical outcomes.
Wherever you go in life, it’s your ankles that take you there. That’s why Wright Medical has worked for the past decade to innovate solutions to relieve ankle pain. With our INFINITY™ Total Ankle System and INBONE™ Total Ankle System, we go a step beyond relieving ankle pain by creating implants that attempt to restore natural motion.
Because no two ankles are exactly alike, we’ve designed our total ankle systems to offer your doctor options to fit your ankle and increase your satisfaction.
Wright’s ankle replacements are made from highly biocompatible materials similar to those materials used in hip and knee replacement implants; with the main metals being titanium and cobalt chrome.
Available only from Wright, this navigation system enables your doctor to envision your ankle’s unique anatomy and anticipate possible contingencies in advance of your surgery. While relaxing in his office, your doctor can run through every aspect of your individualized surgical plan. The patient-specific alignment guides are designed to aid in accurate implant alignment, which impacts your implant’s long-term performance.
Proper sizing and alignment is crucial because it impacts your implant’s long-term performance. Generally, accurate sizing and alignment results in a longer-wearing, better-performing joint. In a study of the ankle replacement surgeries using the PROPHECY™ Preoperative Navigation System, the size of the tibial component was accurate in 98% of patients. Alignment was within 5 degrees or less of the target in 100% of patients1.
1 Accuracy and Reproducibility Using Patient-Specific Instrumentation in Total Ankle Arthroplasty
J Daigre et al. Foot Ankle Int 38 (4), 412-418. 2016 Dec 07.
To make the most of your time with your physician, plan your questions in advance. The questions below can be helpful when talking to your physician about ankle pain.
1. How did my ankle arthritis develop?
2. How does an ankle replacement differ from an ankle fusion?
3. How similar is an ankle replacement to a knee replacement?
4. Will my ankle replacement help to alleviate the pain?
5. How long will the surgery take and are there any other procedures that need to be performed?
6. What can I expect the post-operative recovery to be like for an ankle replacement?
7. Will I have to do Physical Therapy after my ankle replacement?
8. What kind of activities can I return to after an ankle replacement?
• Focus on your health before surgery
In the weeks leading up to your surgery, maintain an exercise program approved by your physician. If you smoke or drink alcohol, stop. These activities can impair your body’s ability to heal. If you are overweight, focus on safely losing weight — just a few pounds can make a difference. Check with your primary care provider to make sure that your vaccines are up to date. See your dentist. Severe gum disease, an abscess or other oral infection could delay surgery. Keep in mind that mouth germs can enter your bloodstream and infect your new ankle joint.
• Plan ahead to cover your bases
Have someone go with you to all your pre-op appointments and take careful note of all instructions. Arrange for post-surgical care and rehabilitation services well in advance. Double check paperwork with your insurance company and the hospital. Confirm that you have reliable transportation to and from the hospital. You won’t be able to drive post-surgery — run your errands in advance.
• Get your house in order
Identify any slipping or tripping hazards such as area rugs or tricky steps and remove them or devise a plan to work around them. If you have pets, arrange for someone to care for them outside of your home post-surgery. An excited pet jumping up on you or underfoot could cause you to trip or fall.
• CT Scan for PROPHECY™ Preoperative Navigational System
If your physician uses the PROPHECY™ Preoperative Navigational System, you may be asked to get a CT scan. It will be important for the facility to fulfill the CT scan following PROPHECY™ protocol. This important step can help ensure accurate implant sizing and alignment, which can positively impact your new joint’s long-term success.
• 24 Hours Before Surgery
Take only the prescriptions and over the counter medications approved by your physician for use before surgery. Fill any new prescriptions in advance and take as instructed. Follow dietary instructions, which will include fasting the night before.
To prevent pain during surgery, you’ll receive anesthesia. General anesthesia will put you to sleep. With a nerve block, you will be awake during surgery.
• During surgery
If your physician uses the PROPHECY™ system, he will use the alignment guides designed for your unique anatomy to perform the cuts required for your ankle to receive the implants. These patient-specific guides are shown to help ensure correct alignment*, a key factor in your implant’s long-term performance. Next, your physician will remove damaged bone and cartilage. Then your physician will smooth the bones’ surfaces and insert the implant components. Most ankle replacement surgeries are completed in 1-1/2 to 3 hours. (PROPHECY™ alignment guides are only available with Wright’s total ankle systems.)
*Berlet GC, Penner MJ, et. al. FAI 2014
You can expect numbness in your leg up to 18 hours following surgery. As feeling returns, you may experience some minor pain, which will be managed with oral pain and/or IV medications. A dressing will cover the surgery site. A splint will protect your ankle from injury.
NOTE: The above information is based on a general protocol. You should follow the post-op protocol provided by your doctor. Protocols can vary by doctor and individual patient factors. Sample Postoperative Care Protocols (What To Expect After Surgery).