Ankle Replacement Treatment

Introduction

Ankle Arthroplasty (Ankle Replacement) is a surgical process done to change the destroyed articular surfaces of the ankle joint with the help of prosthetic components. This procedure becomes the treatment of choice for patients who require arthroplasty, replacement of the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature which is favorable in the ankle replacement with respect to arthrodesis.

Patients who require ankle replacement surgery

Ankle replacement surgery may be required by the patients if they have severe arthritis in their ankle. This can cause symptoms like severe pain, inflammation, and stiffness, which leads to difficulty in walking. The main types of ankle arthritis are as follows:

• Osteoarthritis: This is the “wear and tear” type of arthritis that develops in adults who are older in age.
• Rheumatoid arthritis: Rheumatoid arthritis is a system-wide autoimmune disease that affects the joints of the patients.
• Arthritis: This can happen due to past injuries of the joint.

If the patients have mild or moderate arthritis, their healthcare provider may recommend other treatments like physical therapy, pain medicines, special shoe and foot inserts, or corticosteroid injections. If the patients still have severe symptoms that interfere with their day to day activities, their healthcare provider may recommend ankle replacement or another surgical procedure. If the patient’s arthritis is not yet severe, arthroscopic debridement might be a better option. Ankle fusion is another option for people who have severe arthritis. Each of these options has its own risks and benefits.

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Who should not have an Ankle Replacement?

Not everyone requires an ankle replacement. The patients whose ankles are severely deformed or have had an infection in the past may opt for ankle fusion. Patients with serious medical problems or blood flow problems should not consider ankle replacement.

Treatment Option

Non-Surgical treatment may include:

• Orthotics: Changing the alignment of the foot or ankle can help in improving the symptoms.
• Bracing: Braces ranges from sports braces with laces and velcro to custom sturdy leather braces.
• Physical therapy: Therapy is most effective when arthritis leads to instability. Therapy can help in improving the stability of the ankle by strengthening the muscles. Therapy can also help keep the ankle moving, which is vital for maintaining healthy joints.
• Medications: Nonsteroidal anti-inflammatory drugs, such as naproxen, or meloxicam, ibuprofen may be prescribed for reducing pain and inflammation.
• Steroid Injections: Injecting a steroid into the ankle joint can significantly reduce the pain and reduce inflammation.
• Activity Modification: Athletic individuals may change the intensity and frequency of the sports that they play. 

If the non-surgical management fails to relieve pain adequately, surgery is probably the last option, but before undergoing surgery the patient must discuss with their foot & ankle surgeon. If symptoms are mild the surgeon may suggest using arthroscopic techniques. It generally involves the use of a very small camera for evaluating the ankle and small instruments for removing damaged cartilage and damaged tissue. Arthroscopic procedures use small cuts and are minimally invasive.

Surgical Procedure

With the surgical procedure, the motion is preserved at the ankle. This reduces the stress on the joints of the foot and thus decreasing the chances of developing arthritis in them. New implant designs have much better success than older designs. The ability of the new ankle joint to move up and down is an advantage over an ankle fusion. But like all other joint replacements, an ankle replacement can wear out with time. An ankle replacement is generally performed under general anesthetic with a nerve block. Bone is then cut and removed, which allows the placement of the metal and plastic components that re-create the ankle joint. The wound is then closed with the help of stitches and then a splint is applied. The patient is typically non weight bearing for 2-3 weeks for allowing the incision to heal. Once the incision is healed, the patient can bear weight in a boot and physical therapy can be started. Recovery from an ankle replacement may take about 6 to 12 months.

What are the Risks involved?

As with all the major surgical procedures, the complications can occur. Some of the complications following artificial ankle replacement are Infection, Loosening and Nerve Injury.

Infection: Infection can be a very serious complication that can occur after artificial joint replacement surgery. The chance of getting an infection following artificial ankle replacement is probably around 2% to 4%. This is higher than the risk of infection after a hip or knee replacement. Some infections may show up very early, even before the patients leave the hospital, others may not become visible for months, or even years, after the operation. Infection can spread into the artificial joint from the other infected areas. The surgeon will make sure that the patients take antibiotics when they have dental work or surgical procedures on their bladder and colon to reduce the risk of spreading germs to the joint.

Loosening: The main reason that artificial fails are because of the process of loosening where the metal or cement meets the bone. There has been great advancement on how long an artificial joint will last, but most of them will eventually get lose and is required a revision. In the past, the artificial ankle has not been considered as successful as the hip and knee replacement because there has been a higher risk of loosening and the failure of the artificial ankle replacement. Many of them only last for 5-8 years. The risk of loosening is very much higher in younger, more active patient and the patient who is overweight. A loose prosthesis is a problem because it can result in pain. Once the pain becomes unbearable, another operation might be required to either revise the ankle replacement or for performing an ankle fusion.

Nerve Injury: All the nerves and blood vessels that go to the foot travel across the ankle joint. Because the operation is performed so close to these important structures, there is a possibility that either the nerves or the blood vessels get injured during surgery. It is very rare to have permanent injury to either the nerves or the blood vessels, but it is still possible.

Surgically replacing the injured ankle bones and joints with artificial joints, usually composed of metal and plastic, is known as ankle replacement surgery or ankle arthroplasty. People with severe ankle discomfort and incapacity from arthritis or other degenerative joint disorders are typically advised to have this treatment. Compared to hip or knee replacement surgery, it is typically thought to be a more extensive and sophisticated procedure that may need a longer recovery period.

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Need for ankle replacement 

An ankle joint issue may be indicated by a number of symptoms. Typical symptoms include the following

• Pain: Ankle joint pain can be felt while standing or walking, and it can get worse with particular activities.
• Swelling: Ankle joint swelling may result from fluid accumulation or inflammation in the joint.
• Stiffness: It may feel difficult to move or bend the ankle joint because it is rigid or inflexible.
• Instability: If the ankle joint feels unstable or like it's "giving way," there may be an issue with the muscles or ligaments that surround the joint.
• Limited range of motion: A problem with the joint may be indicated by the ankle joint being difficult to move or not moving as far as it should.
• Deformity: If the ankle joint is noticeably malformed or deformed, this could indicate a joint issue.

Who is not a candidate for ankle joint replacement?

A new ankle is not a suitable option for every person with ankle arthritis. It won't fit you properly if your ankles are severely unstable or deformed. Comparably, for patients with the following specific medical conditions, healthcare providers might not propose replacement:

• Diabetes
• Being overweight
• Infections of the bone
• Issues with circulation

Types of ankle replacement surgery

Ankle replacement methods come in a variety of forms, and the choice of operation is contingent upon the unique circumstances of the patient as well as the surgeon's recommendations based on the patient's diagnostic testing.

• Total ankle replacement surgery
• Ankle resurfacing
• Revision ankle replacement

Total ankle replacement surgery

It is the most common type of surgery for replacing an ankle. The patient's tibia, talus, and occasionally fibula are all replaced with prosthetic implants during the treatment, which replaces the patient's whole ankle joint.

Ankle resurfacing

Compared to a total ankle replacement, the treatment is less invasive. In this surgery, the patient's tibia and talus are solely surgically treated, with the healthy bone remaining in place and only the damaged cartilage and bone surfaces removed and replaced with metal pieces.

Revision ankle replacement

When an ankle replacement device that has already been implanted needs to be modified or replaced because of problems including wear and tear, implant failure, or complications, surgery is done.

Various techniques for total ankle replacement

Different surgical procedures, such as open surgery, minimally invasive surgery, and in certain situations, robotic-assisted surgery, can be used to accomplish ankle replacement surgery. The particular condition of the patient, the surgeon's skill, and the state of the technology at the site will all influence the surgical strategy used. 

Diagnostic tests before undergoing ankle replacement surgery

An orthopedic surgeon might suggest the following tests before undergoing an ankle replacement:

• Medical history
• Physical examination: ankle mobility, strength, and stability will all be measured during a physical examination.
• X-ray tests: X-rays are useful for figuring out how serious an ankle injury is.

After discussing the findings of your evaluation with you, your orthopedic specialist will determine if an ankle replacement is the best course of action to reduce your discomfort and enhance your function.

Procedure for ankle replacement surgery

An orthopedic surgeon will perform ankle replacement in concert with a team of exceptionally talented medical professionals. The surgery may take several hours to finish.

• You won't experience any pain or discomfort throughout the surgery because you will be given a general anesthesia.
• A medical professional will monitor your vital signs, such as your heart rate and blood pressure, closely throughout the treatment.
• Prior to creating an incision through the muscle and skin of your ankle, your surgeon will clean the affected region.
• Your surgeon will remove your injured shin bone and talus.
• Your surgeon will then attach the new metal joint surfaces to the pieces of your residual bones. They may use a particular type of cement to set them firmly.
• In order to allow the new metal joint spaces to freely glide against one another, your surgeon will most likely also implant a piece of plastic between them.
• Your foot and ankle’s cutaneous and muscular layers will be surgically sealed by the surgeon.

Recovery after the surgery

Recovery from an ankle replacement treatment can take anywhere from six to twelve months.A walker or crutches are typically used by individuals who have a cast or splint. Because of the split or cast, the ankle cannot move until it heals. It's possible that your doctor will recommend blood clot prevention medication to you at this time. After surgery, physical therapy can help you regain ankle mobility.

Why choose India for ankle replacement surgery?

The availability of the best ankle replacement surgeons in India at a cost lower than most of the countries is why patients choose to come to the country. When it comes to this delicate operation, their expertise and experience are one of the best in the world. The physiotherapy that occurs after the procedure also plays a key role in the successful operation, and some of the best physiotherapists are also considered to be housed in India.

Factors affecting ankle replacement cost in India

Compared to other industrialized nations, ankle replacement surgery in India is more reasonably priced. Along with some of the greatest medical facilities and cutting edge technology, the nation is home to renowned orthopedic physicians. The following is a summary of some of the variables influencing ankle replacement surgery costs in India.

• The type of implant selected
• Hospital’s location and infrastructure
• Expertise and experience of the medical professionals
• Duration of the treatment
• Types of diagnostic tests
• Anesthesia 

Best hospitals for ankle replacement surgery in India

• C K Birla hospital, Gurugram
• Fortis Memorial Research Institute, Gurgaon
• Fortis Vasant Kunj Hospital, New Delhi
• Medanta The Medicity, Gurugram
• Artemis Hospital, Gurugram
• Max Hospital, Delhi
• Apollo Hospitals, Delhi

Best surgeons for ankle replacement in India

• Dr. Anuj Chawla
• Dr. Subhash Jangid
• Dr. Manoj Miglani
• Dr.  Ashok Rajgopal
• Dr. IPS Oberoi
• Dr. S. K. S. Marya
• Dr. Yash Gulati

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FAQ

1. What are the risks of undergoing ankle replacement surgery?

• Among the risks of ankle replacement surgery include ankle instability, stiffness, weakness, and artificial joint deterioration over time.

2. What is the success rate of ankle replacement surgery?

• In 90% of cases, the replacement lasts ten years. Though they normally live even longer, occasionally an implant may fail in less than ten years. Ankle replacements may become less snug over time. If there is any movement of the metal piece inside the bone, pain and edema could occur.

3. Is it possible to have a regular life after surgery on the ankle?

• With the correct care and attention, the majority of people may recover after ankle surgery and return to their normal activities. However, it's imperative that you follow your doctor's instructions and be patient as your body heals.

 4. How to book or schedule an appointment for ankle replacement surgery in India?

• We will assist you in getting expert advice and the best treatment from a panel of cardiac specialists. You can contact us via phone at +91-9289678787 or email us at care@getwellgo.com