What is Total Ankle Replacement?

This procedure involves removing an arthritic ankle joint and replacing it with metal and plastic components which simulate normal ankle range of motion.

Why does arthritis form?

There are many types of arthritis. Autoimmune disorders like rheumatoid and psoriatic arthritis are conditions caused by the body’s own cells attacking the joints. Arthritis can also be caused by a traumatic injury to the joint, like an impaction that destroys the cartilage cells or a fracture through a joint. Repetitive ankle sprains also cause loosening of the ligaments around the joint and lead to abnormal wearing and changes to the joint surfaces.

Who is a good candidate for the procedure?

Ankle replacements are utilized to treat end-stage ankle arthritis, which typically forms due to a previous injury to the joint but may also form due to a systemic arthritis like gout or rheumatoid arthritis. Ankle replacements are not as long-lasting as knee and hip replacements, so the ideal candidate is someone who is age 65 or older, has a BMI below 30, and does not have any neurological or vascular deficiency to the feet and ankles. The goal is to reduce the risk of a poor outcome requiring additional surgery. Exceptions to the age rule may be made on an individual basis, but there are no exceptions for the neurovascularly compromised.

What is the recovery like?

The procedure typically requires 2 weeks of non-weight bearing activity followed by a 6 week period of rehabilitation and therapy. Patients are typically able to walk comfortably in a brace between 2 and 3 months after surgery.

To give the best long-term outcome, we must correct the underlying problem which caused the arthritis in the first place. This sometimes requires a reconstructive foot procedure which involves repositioning the heel centrally under the leg. This procedure requires 6 weeks of non-weight bearing activity, so we will typically stage the reconstruction first, and 4 weeks later perform the ankle replacement procedure.

Patients with ankle replacements are limited to walking, biking, swimming, and golf after surgery. They should not run or jump due to the excessive amounts of pressure which are placed across the prosthesis. Doing so may result in collapse of the implant into the bone, requiring a revisional ankle fusion.

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Arthritic changes to the ankle occur very frequently and are usually the result of a previous injury to the joint, such as a fracture or ligament tears. It can also form as the result of normal wear and tear over the course of many years. Patients who develop ankle arthritis have traditionally been left with few treatment options, such as bracing, cortisone injections, and ultimately ankle fusion. Ankle fusion is when the joint surfaces are completely removed, and the bones are fused into one solid bone. This eliminates motion at the joint. What happens in the following years are that the joints around the ankle start to become arthritic. Once the joints of the hindfoot become arthritic, the only option is to fuse them as well. A rigidly fused hindfoot and ankle gives patients a non-functional limb on which they must walk for the duration of their lives. This leads to chronic knee, hip, and back pain.


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Total ankle arthroplasty, also known as an ankle replacement, is an alternative to ankle fusion to treat end-stage ankle arthritis. With a total ankle replacement, we can keep the ankle moving and eliminate pain simultaneously. By maintaining motion in the ankle, we can reduce stress on the joints surrounding the ankle. This substantially reduces the chances of developing arthritis in them. There are currently 10 FDA approved ankle replacements in the US, and with the new implant designs we are finding much better success than the designs of the past. These new designs function very similar to our natural ankle, helping patients to walk the way nature intended. Not everyone with ankle arthritis is a good candidate for an ankle replacement.

Dr. Walimire will evaluate your overall health and function to determine if you are a candidate for the procedure.


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Since the lifespan of an ankle replacement is about 15 years, it is preferential to perform the procedure on those who are age 60 and older who do not perform high impact activities.

Dr. Walimire is one of the most prominent ankle replacement surgeons in southwest Florida. He is certified on six total ankle replacement systems and has performed many successful procedures. We are happy to provide a consultation for you if you are living with chronic ankle pain.