Ankle Replacement Surgery

Preparing for Ankle Replacement Surgery

The decision to proceed with ankle replacement surgery should be made only after you feel fully informed about the procedure and understand what to expect before, during, and after surgery.

Your foot and ankle surgeon will work closely with your primary care physician before and after ankle replacement surgery. An orthopedic surgeon specializes in conditions affecting the bones, joints, and muscles, while your primary care physician understands your overall medical history and individual health needs.

Together, these doctors determine whether special preparation is needed and whether additional specialists should be involved. Patients are encouraged to schedule an appointment with their primary care physician during the surgical planning process so any special medical needs can be communicated.

If you have not had a recent physical examination, your primary care physician may recommend one to identify any new or previously undetected medical conditions. This may help reduce surgical risks. After surgery, follow-up visits with both doctors may be recommended to ensure optimal orthopedic and medical care.

Preoperative Planning & Physical Therapy

Once the decision to proceed with surgery is made, several preparatory steps may take place. Your surgeon may recommend a complete physical examination to ensure you are in the best possible condition for surgery.

You may also meet with the physical therapist who will oversee your rehabilitation after surgery. In some cases, therapy education begins before surgery to prepare you for recovery. This may include measuring pain levels, functional abilities, strength, and range of motion of each ankle.

You may begin practicing the use of crutches or a walker, which will be required for several weeks after surgery. An assessment will also be made to determine any assistance you may need at home after discharge.

You will typically be admitted to the hospital early in the morning on the day of surgery and instructed not to eat or drink after midnight the night before. Most patients remain in the hospital for one to two nights depending on recovery progress, pain control, and mobility.

Ankle replacement surgery may be performed under general anesthesia, regional anesthesia, or spinal anesthesia.

During Ankle Replacement Surgery

The Incisions

The operation begins with an incision made at the front of the ankle, known as an anterior approach.

Cutting the Bones

The next step involves cutting the bones that form the ankle joint socket—the tibia and fibula—so the metal socket component can fit properly. The top of the talus is also cut to allow placement of the talar implant.

Inserting the Implant

The tibial and talar components of the artificial ankle joint are inserted and tested to ensure proper fit and alignment.

Inserting the Screws

To secure the ankle mortise, screws are placed between the tibia and fibula above the artificial ankle joint.

Bone Grafting

Bone graft material taken from bone removed earlier in the procedure is placed between the tibia and fibula. This promotes fusion between the two bones and helps prevent motion that could loosen the implant.

Closing the Incision

Once the surgeon is satisfied with the implant placement, the joint capsule and skin are closed. Closure may be performed using stainless steel staples, dissolvable sutures, nylon stitches, or adhesive tape closures. Each method has advantages, and the choice depends on the surgeon’s preference and the patient’s needs.

A bandage and splint are applied to protect the ankle during healing.

Other Surgical Procedures

Because ankle implants must be precisely aligned, additional soft tissue procedures may be required to restore ligament tension and proper ankle alignment. Your surgeon will discuss the need for any additional procedures based on your individual condition.

Ankle Replacement Surgery Components

Total ankle replacement uses artificial components designed to replicate normal ankle movement. The tibial component typically includes a titanium base plate and a polyethylene bearing surface. The talar component replaces the upper portion of the talus and is commonly made of cobalt chromium alloy.

One example of an ankle prosthesis is the SALTO TALARIS Total Ankle Prosthesis, which is designed to replicate natural ankle movement based on detailed anatomical studies.

Recovery & Rehabilitation

After surgery, you will recover in the post-anesthesia recovery room until your vital signs stabilize. Pain medication will be provided as needed, and your ankle will remain immobilized in a splint.

Blood on the dressing during the first few hours is common. The day after surgery, you may begin sitting up, getting out of bed, and starting gentle physical therapy. Dressings are typically removed after two days, and ankle motion may begin under therapist guidance.

You will not bear weight on the ankle for approximately six weeks and will use crutches or a walker. Sutures are generally removed about two weeks after surgery.

Physical Therapy After Ankle Replacement Surgery

Inpatient physical therapy usually begins one day after surgery and may occur twice daily. Therapy focuses on gentle movement, safe transfers, and walking with assistive devices.

Outpatient physical therapy includes detailed evaluation of pain, swelling, gait, range of motion, strength, posture, and joint mobility. Therapy is designed to restore function and protect the new ankle joint.

Recovery at Home & Activity Guidelines

Until your first follow-up visit, it is important to keep your incision clean and dry. If you notice drainage, a foul odor, increased swelling, or tenderness around the incision, contact your surgeon. You should also call your surgeon if your temperature exceeds 100.4 degrees.

You will remain non-weight bearing on the affected ankle for approximately six weeks and will use crutches or a walker during this time. When resting, elevate your ankle whenever possible, preferably above the level of your heart.

You may walk as much as you like using crutches or a walker, but you must avoid placing weight on the surgical ankle until your surgeon provides clearance. Exercises prescribed by your surgeon or physical therapist should be performed two to three times per day.

For bathing, sit in the bathtub and wash while keeping your ankle dry until sutures are removed. Plastic covering may be used to protect the ankle when showering. Normal bathing may resume after sutures are removed.

It is normal to feel frustrated during recovery. These feelings typically improve as mobility and comfort increase. Assistance from family or friends with daily activities may be helpful during the early recovery period.

Physical Therapy Evaluation & Rehabilitation Process

Prior to surgery, some patients may meet with a physical therapist for a preoperative evaluation. This visit establishes baseline measurements including pain levels, functional abilities, strength, and range of motion in each ankle. Patients may also practice postoperative exercises and learn to safely use crutches or a walker.

Inpatient physical therapy typically begins one day after surgery and may occur twice daily for up to four days. Therapy focuses on gentle movement, safe transfers, and walking short distances with assistive devices. Patients are generally discharged once they can safely get in and out of bed, walk approximately 75 feet, and navigate stairs.

Outpatient physical therapy includes a detailed evaluation of posture, swelling, gait, range of motion, and strength. Swelling may be measured using tape measurements or volumetric testing. Gait analysis ensures proper weight-bearing and safe use of assistive devices.

Range of motion is assessed in all directions, including dorsiflexion, plantarflexion, inversion, and eversion. Strength testing evaluates muscles around the ankle, knee, and hip. Manual examination and palpation are used to assess joint movement, muscle flexibility, tenderness, and swelling.

These evaluations guide the rehabilitation plan to restore movement, improve strength, reduce pain, and protect the new ankle joint.

Long-Term Care & Special Instructions

Follow-up visits are typically scheduled at six weeks, three months, and six months after surgery, including X-rays to monitor healing and implant position.

Patients should always inform healthcare providers, including dentists, that they have an artificial joint. Antibiotics may be required before certain medical or dental procedures to reduce infection risk. Prompt treatment of infections is essential to protect the implant.

Potential Complications Following Ankle Replacement Surgery

As with all major surgical procedures, complications can occur. Common risks include infection, implant loosening, and nerve injury.

Signs of possible complications include delayed wound healing, increased pain, swelling, drainage, fever, reduced motion, instability, or pain after a fall. Imaging such as X-rays may be required to evaluate concerns.

Monitoring Implant Health & Long-Term Outcomes

Ankle replacement surgery is intended as a long-term treatment option, but implants may wear out or fail over time. The lifespan of an ankle implant depends on factors such as activity level, body weight, and bone quality surrounding the joint.

Signs that may indicate problems with an ankle implant include delayed wound healing, increased pain, swelling, drainage, fever, reduced motion, instability, or pain following a fall. If these symptoms occur, patients should contact their doctor promptly. X-rays are commonly used to evaluate implant position and detect complications.

One of the most common long-term complications is implant loosening, which occurs where the metal or cement meets the bone. Loosening is more common in younger, highly active patients and those who are overweight. As pain increases, additional surgery may be required to revise the ankle replacement or perform an ankle fusion.

Infection can occur shortly after surgery or years later and may spread from other areas of the body through the bloodstream. Any infection should be treated promptly to reduce the risk of spreading to the artificial joint.