Ankle replacement

Answer 1

Definition

Ankle replacement is surgery to replace the damaged parts of the three bones that make up the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. They come in different sizes to fit different-size people.

Alternative Names

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery

Description

Ankle replacement surgery may be done while you are under general anesthesia. This means you will be unconscious and unable to feel pain. Or, you may have spinal anesthesia. You will be awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be given medicine to help you relax during the operation.

Your surgeon will make an incision (cut) in the front of your ankle to expose the ankle joint. Then your surgeon will gently push the tendons, nerves, and blood vessels to the side. After this:

• Your surgeon will remove the damaged bone.
• Your surgeon will reshape 3 of your bones that will remain in place:
  • The lower end of your shin bone (tibia)
  • The lower end of your smaller lower leg bone (fibula)
  • The top of your foot bone (talus) that the leg bones rest on
• The parts of the new artificial joint are then attached. A special glue may be used to hold them in place. Often, screws are also placed through the two leg bones (fibula and tibia) to help support the artificial ankle.
• A bone graft is created between the ends of the fibula and tibia. This makes your new ankle more stable.

After putting the tendons back into place, the surgeon closes the wound with sutures (stitches). You may need to wear a brace for a while to keep the ankle from moving.

Why the Procedure Is Performed

Ankle replacement surgery may be done if the ankle joint is severely damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

• Osteoarthritis
• Rheumatoid arthritis
• Bone fracture
• Arthritiscaused by ankle surgery in the past

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Blood clot
• Infection

Risks for ankle replacement surgery are:

• Loosening of the artificial joint over time
• Nerve damage
• Blood vessel damage
• Bone break during surgery
• Ankle weakness, stiffness, or instability
• Dislocation of the artificial joint
• Allergic reaction to the artificial joint

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your Doctor Who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You may want to visit the physical therapist to learn some exercises to do before surgery. The physical therapist can also teach you how to correctly use crutches.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will need to stay in the hospital for up to 4 days.

Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the ankle joint will be left in your ankle for 1 or 2 days. To keep swelling down, you can keep your foot raised higher than your heart while you are sleeping or resting.

Your doctor may recommend physical therapy to learn exercises that will help with ankle motion.

Outlook (Prognosis)

A successful ankle replacement will get rid of your pain and allow you to move your ankle to up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

References

Ishikawa SN. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 5.

Answer 2

Definition

Ankle replacement is surgery to replace the damaged parts of the three bones that make up the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. They come in different sizes to fit different-size people.

Alternative Names

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery

Description

Ankle replacement surgery may be done while you are under general anesthesia. This means you will be asleep and pain-free. Or, you may have spinal anesthesia. You will be awake but will not feel anything below your waist. If you have spinal anesthesia, you will also be given medicine to help you relax during the operation.

Your surgeon will make a surgical cut in the front of your ankle to expose the ankle joint. Your surgeon will then gently push the tendons, nerves, and blood vessels to the side. After this:

• Your surgeon will remove the damaged bone.
• Your surgeon will reshape three of your bones that will remain in place:
  • The lower end of your shin bone (tibia)
  • The lower end of your smaller lower leg bone (fibula)
  • The top of your foot bone (talus) that the leg bones rest on
• The parts of the new artificial joint are then attached to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. Often, screws are also placed through the two leg bones (fibula and tibia) to help support the artificial ankle.
• A bone graft is created between the ends of the fibula and tibia. This makes your new ankle more stable.

After putting the tendons back into place, the surgeon closes the wound with sutures (stitches). You may need to wear a brace for a while to keep the ankle from moving.

Why the Procedure Is Performed

Ankle replacement surgery may be done if the ankle joint is severely damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

• Arthritiscaused by ankle surgery in the past
• Bone fracture
• Infection
• Osteoarthritis
• Rheumatoid arthritis

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Bleeding
• Blood clot
• Infection

Risks for ankle replacement surgery are:

• Allergic reaction to the artificial joint
• Ankle weakness, stiffness, or instability
• Blood vessel damage
• Bone break during surgery
• Dislocation of the artificial joint
• Loosening of the artificial joint over time
• Nerve damage
• Skin not healing after surgery

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You may want to visit the physical therapist to learn some exercises to do before surgery. The physical therapist can also teach you how to correctly use crutches.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will need to stay in the hospital for 3 to 4 days.

Your ankle will be in a cast or a splint after surgery. A small tube that helps drain blood from the ankle joint may be left in your ankle for 1 or 2 days. To keep swelling down, keep your foot raised higher than your heart while you are sleeping or resting.

Your doctor may recommend physical therapy to teach you exercises that will help you move more easily.

Outlook (Prognosis)

A successful ankle replacement will get rid of your pain and allow you to move your ankle up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

References

Ishikawa SN. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 5.

Hansen ST Jr. Post-traumatic reconstruction of the foot and ankle. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, Krettek C, eds. Skeletal Trauma. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Reviewed By

Review Date: 02/19/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, Unviersity of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Definition

A partial knee replacement is surgery to replace either the inside (medial) or outside (lateral) parts of the knee. It is called a partial replacement because only one part of the damage knee is replaced.

See also: Total knee replacement

Alternative Names

Unicompartmental knee arthroplasty; Knee replacement - partial; Unicondylar knee replacement; Arthroplasty - unicompartmental knee; UKA; Minimally invasive partial knee replacement

Description

Partial knee replacement surgery removes damaged tissue and bone in the knee joint and replaces the area with a man-made implant, called a prosthetic.

Before surgery, you will be given anesthesia, which is medicine that blocks pain. You will have one of two types:

• General anesthesia makes you unalert and unable to feel pain.
• Regional ( spinal or epidural) anesthesia numbs you below your waist. You will also receive medicines to make you relax or feel sleepy.

The surgeon will make a cut over your knee.This cut is about 3 to 5 inches long.

• Next, the doctor examines the entire knee joint. If there is damage to more than one part of your knee, you may need a total knee replacement. Most of the time, however, this is not needed.
• The damaged bone and tissue is removed.
• A man-made part made of plastic and metal is placed into the knee.
• Once it is in the proper place, it is secured with bone cement.
• The wound is closed with stitches.

Why the Procedure Is Performed

The most common reason to have a knee joint replaced is to relieve severe Arthritis pain. Your doctor may recommend knee joint replacement if you have:

• Symptoms of knee arthritis, including knee pain that keeps you up at night or prevents you from doing daily activities
• Knee pain that continues despite other treatments

You will need to understand what surgery and recovery will be like.

Partial knee arthroplasty may be a good choice if you have arthritis on only one side of the knee, and you:

• Are older, thin, and not very active
• Do not have very bad arthritis on the other side of the knee or under the kneecap
• Have only minor deformity of the knee
• Still have good range of motion in the knee

However, most people with knee arthritis have a surgery called a total knee arthroplasty (TKA).

Knee replacement is usually done in people age 60 and older.

Risks

Risks for anesthesia include:

• Problems breathing
• Reactions to medications

Risks for any surgery include:

• Bleeding
• Infection

Risks for UKA include:

• Blood clots
• Fluid buildup in the knee joint
• Implant failure
• Nerve and blood vessel damage
• Pain with kneeling
• Reflex sympathetic dystrophy (rare)

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, including herbs, supplements, and medicines bought without a prescription.

During the 2 weeks before your surgery:

• Ask your doctor which medicines you can still take on the day of your surgery.
• You may be asked to stop taking medicine that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• You may need to stop taking any medicines that weaken your immune system, including Enbrel and methotrexate
• If you have Diabetes, Heart disease, or other medical conditions, your surgeon will ask you to see the doctor who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol (more than one or two drinks a day).
• If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking slows healing and recovery.
• Let your doctor know if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.
• You may want to visit a physical therapist before surgery to learn exercises that can help you recover.
• Practice using a cane, walker, crutches, or a wheelchair. You will need to learn how to:
  • Get in and out of the shower
  • Go up and down stairs
  • Sit down to use the toilet and stand up after using the toilet
  • Use the shower chair

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 - 12 hours before the procedure.
• Take the drugs your doctor told you to take with a sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most patients go home the day after surgery.

You can put your full weight on your knee right away.

After surgery, you will be encouraged to do as much as you can for yourself. This includes going to the bathroom or taking walks in the hallways, always with someone helping you.

Most patients recover quickly and have much less pain than they did before surgery. People who have a partial knee replacement recover faster than those who have a total knee replacement.

Outlook (Prognosis)

Many patients are able to walk without a cane or walker within 3-4 weeks after surgery. You will need physical therapy for 4 to 6 months.

Most forms of exercise are okay after surgery, including walking, swimming, and biking. However, you should avoid high-impact activities such as jogging.

References

Crockarell JR, Guyton JL. Arthroplasty of the knee. In: Canale ST, Beatty JH, ed. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 6.

Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005;87(5):999-1006.

Patil S, Colwell CW Jr, Ezzet KA, et al. Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am. 2005;87(2):332-338.

Richmond J, Hunter D, Irrgang J, et al. American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg. 2009;17:591-600.

Reviewed By

Review Date: 09/23/2011

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.