Total ankle replacement

Daniel Murawski, M.D.
Orthopaedic Surgeon / Foot & Ankle Specialist
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 Q: What leads to a patient needing total ankle replacement?
Daniel Murawski, M.D.: A patient may need total ankle replacement surgery when they fail conservative treatment for ankle arthritis. The most common cause of ankle arthritis would be just your regular osteoarthritis or degenerative arthritis that happens with age. You can also have arthritis that occurs after injury such as an ankle fracture or an ankle sprain for that matter. But usually with ankle arthritis, we will first start with standard treatment such as injections, bracing, anti-inflammatory medications, and move on to more aggressive treatment as we need to. But certainly there are a lot of different options before you get to an ankle replacement, but when those other treatments have failed then we start considering ankle replacement surgery. When you have end-stage ankle arthritis there are two main options. One is going to be an ankle fusion and one is going to be an ankle replacement. There are a lot of pros and cons to each approach and that's why you sit down and have a discussion with me about what's the best option for you.
 Q: What can a patient expect to happen during a total ankle replacement?
Daniel Murawski, M.D.: Most ankle replacement surgeries can be done in an outpatient basis. You come to the hospital that morning, you can get you get a nerve block done by anesthesiologist. The surgery is done under general anesthesia and lasts about two hours. Most patients can go home that day because they have no pain which is fantastic which is the result of the nerve block. You’ll have a splint on a splint in place. One thing that makes ankle replacement different from hip or knee replacement surgeries is that you need to be non-weight-bearing postoperatively. So it's somewhat inconvenient compared to the hip or knee replacement surgery and that you need to be non-weight-bearing, but patients get it, you know, they can practice before surgery and you need crutches or one of those knee rollers. It can be quite easy getting around, it's just that period of non-weight-bearing that kind of can be inconvenient for a short period of time. Then after six weeks, I get most patients mobilized and one of those controlled ankle motion (CAM) walkers which can be weight-bearing from about 6 to 10 weeks post operatively. We plan on transitioning patients into a regular shoe around ten weeks postoperatively. It takes around four to six months for full recovery after an ankle replacement surgery.
 Q: What can a patient can expect post operatively with a total ankle replacement?
Daniel Murawski, M.D.: Well, I would say, you know, the gold standard for surgical treatment of ankle arthritis is still ankle fusion. That's when we take the two bones of the ankle and fuse them together. Most patients get a little paranoid when they hear about that as an option, but it's actually quite good. It's a durable surgery. It's excellent for pain relief. The only downside is that you lose some motion, and a lot of patients want to preserve that motion. That's where the ankle replacement surgery comes in. So it's a very selective surgery, you have to be very careful regarding the patients that get a total ankle replacement surgery. So that's a very important conversation you have between the physician and the patient when it comes to choosing between ankle replacement and ankle fusion.


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