Total Ankle Prothesis (Ankle Replacement)

End stage ankle arthritis can be treated with either an ankle prothesis or an ankle fusion. Modern ankle replacements are modelled after the human anatomy and therefore reproduce the natural movement of the ankle.

How is ankle replacement surgery done?
Next to the clinical examination the surgeon of Mein Fusszentrum will ask for radiographs and, in many cases, additional imaging such as an MRI or a Ct scan. The latter allows for careful planning in complex cases.

1. Planning of the implantation

The surgeon uses the weight bearing radiographs in order to carefully plan the implantation of the ankle prothesis. None weight bearing images may lead to implant misplacement.

Picture 1: Preoperative radiographs showing severe ankle arthritis.

 

2. Simulation of the implantation on a 3-dimenstional model

The preoperative data of the radiographs and Ct scans are used to create a 3-dimensional model of each individual patient. The surgeon is now able to simulate the implantation of the implants and determine the ideal position and size of the prothesis. This allows for highest accuracy of the implant positioning.

Picture 2: Simulation of the implantation of the prothesis shown on the patient with the radiographs in picture 1.

 

3. 3-D printing of the custumized instruments

Once the surgeon  of Mein Fusszentrum has determined the ideal position and size of the ankle prothesis, custom made implantation jigs are manufactured on measure.

Picture 3: After the planning the surgeon tests the patients specific implantation guide on the computer model.

 

4. Implantation of the ankle prothesis

The surgeon now is able to implant the prothesis with highest possible precission and thereby improving the function of the foot postoperatively. Additionally, digital preoperative planning reduces the duration of the surgery and thereby reduces complications such as infections or wound break down.

Picture 4: Postoperative radiograph showing accurate implant position.

 

5. Postoperative rehabilitation
The ankle prothesis allows for immediate full weight bearing. Usually the joint is protected in a splint for six weeks.

 

 

FAQ’s

Does ankle replacement give a better quality of life than arthrodesis? 
Ankle prothesis and fusions show similar outcomes, but a well-functioning ankle prothesis leads to higher patient’s satisfaction than a well-functioning ankle fusion.

Can ankle replacement be indicated in patients with ankle joint instability?
Yes, but the surgeon will need to restore ankle joint stability in order to guarantee the long-term outcome.

Is ankle prothesis contraindicated in young patients?
No. Studies have shown favorable results even in young patients after ankle replacement. However, the 10 years survivorship of modern implants is around 85% and therefore the prothesis in many cases will not be a lifetime solution.

Is it possible to implant an ankle prothesis in patients with neurologic disease / diabetes?
Neurologic disease is not an absolute contraindication if it is not a rapidly progressive disease and the joint is stable. In diabetic patients the indications are set very restrictive and only patients with good glycemic control should be considered for ankle replacement.

For total ankle replacement, does surgeons experience influence incidence of complications?
All larger ankle prothesis studies describe a learning curve and state that the critical number in experienced foot and ankle surgeons is about 20 cases. Furthermore, the revision rate in inexperienced surgeons is significantly higher than in experienced surgeons.

 

 

Movies on ankle replacement

Telebasel "Diagnose-Talk" April 2019: Planning of an ankle replacement

Telebasel "Diagnose" April 2019: Ankle replacement

SRF "Puls" 2016: Implantation of an ankle prothesis