Is Ankle Replacement Right for Me? Assessing the Pros and Cons

Ankle replacement has come a long way, even in just the last few years.

Because of the incredibly high pressures and force loads on such a relatively small joint, ankle joint replacements performed 20 or 30 years ago tended to be a lot less successful than other types of joint replacement, such as hips and knees.

But as the technology has improved, ankle replacements are quickly gaining acceptance as a highly beneficial and effective answer to severe arthritis in many situations. At Foot & Ankle Clinics of Arizona, Dr. Spencer Niemann has been performing this surgery regularly for many of his patients, with great success!

However, it’s also important to understand that ankle replacements aren’t for everyone, and may not always be the best answer to your ankle arthritis. So it’s important to carefully consider the options before making a decision that’s best for you and your lifestyle.

The Alternative: Ankle Fusion

Before ankle replacement became a viable alternative, ankle fusion (also known as arthrodesis) was really the only choice for certain severe types of ankle arthritis—and may still be best in some cases.

The really obvious disadvantage of ankle fusion is that it permanently and significantly reduces the range of motion in the joint—especially up-and-down motion. Nearby joints may also be more likely to develop arthritis, since they now have to “pick up the slack” and work harder to compensate for the lack of ankle motion.

That said, your entire ankle won’t typically be “locked” in place, as you should still have some up-and-down motion from the middle of your foot, and side-to-side motion as well. Your walking motion will change to some degree, but the vast majority of people won’t have any visible limp or gait issues for day-to-day activities on flat surfaces.

There are advantages to fusion, too. By completely preventing motion within the arthritic joint, there should no longer be any pain. The fused joint is also incredibly durable, so while the lack of plantar motion may limit your ability to sprint or jump, you typically can engage in most physically demanding jobs and hobbies (biking, hiking, etc.) very safely and comfortably once the ankle has healed.

Weighing the Pros and Cons

The first thing to keep in mind is that any type of surgery for arthritic ankles would typically only be considered at the “end stage” of the condition, when all other non-surgical options have been attempted and failed to provide adequate relief. We will always recommend non-surgical options like physical therapy, orthotics, or laser therapy first if we think they can get you the results you’re looking for.

In terms of surgical options, while total ankle replacement definitely allows better joint function, as we said, the procedure isn’t for everyone. There are some drawbacks, and some contraindications as well.

• Joint lifespan. All mechanical parts wear down over time, even very strong ones, since the body lacks any ability to repair them. A prosthetic ankle may be expected to last about 10-20 years on average, depending on how much wear and tear they have to handle.
• Activity restrictions. Because a prosthetic ankle is less durable than a fused one, it may not be appropriate for people who participate in high-impact athletic activities, or whose job or lifestyle requires heavy manual labor, as this will cause the prosthetic joint to wear out faster.
• Alignment. In order to work efficiently and reduce wear and tear, the replacement joint must be carefully and properly aligned. If you have a moderate to severe hindfoot deformity, an ankle replacement likely will not be a good choice for you (unless the deformity can be corrected beforehand).

So who should consider a total ankle replacement? Here are some factors to consider:

• Age. Due to the more limited lifespan of prosthetic joints, patients who are younger or more active may do better long-term with a fusion. However, if you’re over 50, an ankle replacement may be a better choice for you.
• Weight. If you are overweight or obese, you may require the greater durability provided by an ankle fusion. The cut-off is about 250 pounds.
• Health and activity. The ideal candidate for an ankle replacement is someone who is healthy, active, but not necessarily engaging in high-impact sports or occupations. If you have diabetes, neuropathy, or are at increased risk of infection, an ankle replacement may not be right for you.