Total Ankle Prosthesis (Ankle Replacement)

End stage ankle arthritis can be treated with either an ankle prosthesis 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 prosthesis. 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 prosthesis. This allows for highest accuracy of the implant positioning.

Picture 2: Simulation of the implantation of the prosthesis 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 prosthesis, 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 prosthesis
The surgeon now is able to implant the prosthesis 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 prosthesis allows for immediate full weight bearing. Usually the joint is protected in a splint for six weeks.



Does ankle replacement give a better quality of life than arthrodesis? 
Ankle prosthesis and fusions show similar outcomes, but a well-functioning ankle prosthesis 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 prosthesis 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 prosthesis in many cases will not be a lifetime solution.

Is it possible to implant an ankle prosthesis 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 prosthesis 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

Gesundheitheute June 2020: New ankle joint

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

Telebasel "Diagnose" April 2019: Ankle replacement