What is total ankle replacement (TAR) in Orange County?

Total ankle replacement (TAR), also known as total ankle arthroplasty (TAA), is a surgical procedure that foot and ankle surgeons use to treat ankle arthritis. Arthritic changes may be the result of normal wear and tear due to aging or from a prior injury, such as a broken ankle, dislocation, or ankle sprain. This arthritis may eventually lead to loss of cartilage, pain, and possibly an ankle deformity.

 

What are the indications for ankle replacement surgery?

The goal of TAR is to improve ankle motion so the patient has less pain during activity. TAR is considered in patients that experience ankle pain and decreased function from significant arthritis after failing conservative management. Conservative management includes anti-inflammatory medication, bracing, physical therapy, and activity modification. 

Patients with rheumatoid arthritis may also be good candidates for ankle joint replacement. Other patients who experience significant pain, but do not want a fusion-type procedure that would eliminate the motion at the ankle joint, may also be good candidates for ankle replacement.

 

When should I avoid total ankle replacement?

TAR is not suited for patients with significant deformity or dead bone in the ankle bone (talus). Prior or current infections of the ankle, significant lower extremity neuropathy, inadequate or absent leg muscle function, poor blood flow of the leg, or inadequate soft tissues are also signs that ankle replacement may not be the best treatment option.

 

General Details of the Procedure

Ankle replacement in Orange County is performed under general anesthetic block. A tourniquet is used at the time of surgery to control bleeding and improve visualization. The ankle is approached from the front or the side depending on the type of implant being used. Bone is then cut, allowing for placement of the metal and plastic components that re-create the ankle joint.

Sometimes the patient will have a tight calf muscle or tight Achilles tendon that needs to be lengthened to improve range of motion of the ankle. The wounds are then closed using stitches or staples, and a splint is applied. A period of non-weightbearing in either a cast or cast boot is necessary to allow the implant to heal in the correct position.

 

What happens after surgery?

Recovery from a total ankle replacement in Orange County requires a period of non-weightbearing and immobilization. The procedure is usually performed in an inpatient setting, with the patient spending one to several nights in the hospital. Strict elevation for several days after the procedure is necessary to control swelling and improve wound healing. After the surgical wounds are healed, the foot and ankle surgeon may allow the patient to start working on gentle range-of-motion activities even if they are non-weightbearing. Weightbearing usually begins several weeks after surgery if X-rays show good healing.

 

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

 

Fracture of bone on either side of the total ankle implant is the most common complication. Injury to tendons or nerves and blood vessels is also a possible complication of ankle replacement. Wound healing can be a problem in patients that smoke or have diabetes, or in patients that have rheumatoid arthritis. Another complication that is sometimes seen is the failure of the ankle implant to heal into the bone.

 

Over time, the implant may wear due to normal wear and tear. While modern impants have drastically improved and studies are showing longer implant life, the surgeon may consider exchange of part of the implant or conversion to an ankle fusion if surgical revision becomes necessary.

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Please contact our office in Irvine, Orange, Newport Beach, or Huntington Beach in Orange County, CA to make an appointment with our foot and ankle surgeon / podiatrist (Dr. Coyer) to discuss whether or not you area candidate for total ankle replacement surgery in Orange County.