Ankle issues are common problems in adults. Some severe issues, such as ankle arthritis or joint damage, can require surgery. However, not everyone is a suitable candidate for ankle replacement surgery. There are a lot of factors that come into play when patients evaluate ankle replacement surgery. In this blog, we will discuss what makes a person an ideal candidate for an ankle replacement surgery, and when it’s best to avoid it.
Understanding Ankle Replacement Surgery
Ankle replacement surgery, also known as ankle arthroplasty, is a surgical procedure where a damaged ankle joint is replaced with an artificial implant. This implant is typically made of plastic and metal, and it helps relieve severe pain and stiffness caused by arthritis, joint damage, or pain from previous surgeries. Ankle replacement surgery is recommended to manage severe symptoms and preserve the ankle’s range of motion. A common alternative to ankle replacement surgery is ankle fusion, which joins the bones. However, unlike ankle fusion, ankle replacement surgery removes the damaged bones and replaces them with prosthetics.
Ideal Candidates for Ankle Replacement
Whether or not ankle replacement surgery is a suitable option for you depends on your overall health condition and lifestyle. Individuals who are ideal candidates include:
People With End-Stage Ankle Arthritis Who Haven't Improved With Conservative Treatment
Individuals with end-stage ankle arthritis who have tried all conservative treatment options but still haven’t observed any improvement are recommended ankle replacement surgery as a last resort.
Those With Reasonable Bone Quality and Good Joint Alignment
Ankle replacement surgery is a good option to consider for individuals with reasonable bone quality and good joint alignment. If bone quality is deteriorating or joints are not aligned, ankle replacement surgery is not recommended.
Patients Who Maintain a Healthy Body Weight and Realistic Post-Surgery Expectations
Weight is a critical factor when it comes to ankle replacement surgery because the ankle and feet are the weight bearers of the body. A person can consider ankle replacement surgery if they maintain a healthy body weight and have realistic expectations post-surgery.
Non-Smokers and Individuals Without Major Vascular or Nerve Issues
Ankle replacement surgery is recommended for individuals who are non-smokers and those without major vascular or nerve issues. Smoking or nerve problems can sometimes lead to implant failure or poor wound healing.
Who Is Not a Good Candidate for Ankle Replacement?
Individuals who are not considered good candidates for ankle replacement surgery typically have:
Severe Deformity or Bone Loss
Patients with severe ankle deformity or bone loss are not eligible for ankle replacement surgery because it becomes too difficult to fix a high level of deformity or bone loss with implants. Going ahead with a surgery in such a case may lead to implant failure.
Poor Bone Quality
If bone quality is poor or deteriorating, doctors do not recommend ankle replacement surgery. That is because implants need a healthy, strong bone to get adequate support. Without good bone quality, the implants can experience mechanical failure.
Active Infection or History of Joint Infections
If a patient has an active infection, doctors do not recommend an ankle replacement surgery, because it can lead to the spread of infections and make the surgery ineffective. Similarly, ankle replacement surgery is not recommended for patients with a history of joint infections.
Poor Blood Circulation (peripheral vascular disease)
Poor blood circulation, or peripheral vascular disease, makes a patient unfit for an ankle replacement surgery. That is because insufficient blood flow can greatly impact the body’s natural healing process.
Severe Nerve Damage (neuropathy)
Patients with severe nerve damage or neuropathy are not recommended to go for ankle replacement surgery because neuropathy significantly affects the body’s ability to heal naturally. Surgery in such a case may not provide relief and may make things more complicated.
Morbid Obesity
Morbid obesity is a red flag for ankle replacement surgery, and doctors do not recommend that morbidly obese patients go ahead with the surgery. That is because the weight of the body can stress the implants and lead to significant complications.
Highly Active or Heavy Labor Lifestyle
Individuals with a highly active lifestyle or with jobs that require heavy labor, such as lifting, are not the ideal candidates for ankle replacement surgery. High-impact activities can put extra stress on artificial implants, leading to potential surgical failure.
Uncontrolled Diabetes
Uncontrolled diabetes can increase the risk of serious post-operative complications, including poor wound healing, aseptic loosening of the implants, surgical site infections, and potential charcot neuropathy. Therefore, individuals with uncontrolled diabetes are not ideal candidates for ankle replacement.
Smoking Habit
Individuals with a smoking habit are not suitable candidates for ankle replacement surgery because smoking can dramatically increase the risk of wound infection and failure of the bone to integrate with the implant after surgery.
Younger Patients (typically under 50)
Younger individuals lead a more active lifestyle, which may put more stress on the implants after surgery, risking implant failure/ that is why individuals over 50 are not considered suitable candidates for an ankle replacement surgery.
Common Reasons Surgeons May Advise Against Ankle Replacement
Despite not having a risk factor, in many cases, surgeons still advise against ankle replacement surgery. These instances include:
- Individuals with an unstable ankle joint due to ligament damage
- Patients with active or chronic infections or ulcers
- Individuals who have previously had an ankle fusion
- People with a limited range of ankle motion caused by scar tissue or trauma
- People with unrealistic weight maintenance or recovery expectations.
Alternatives to Ankle Replacement
While ankle replacement may not be a suitable option for all patients, some possible alternatives to this surgery include:
Non-Surgical Options
Patients can keep trying to achieve relief from non-surgical options, such as:
- Physical therapy
- Medications
- Injections
- Bracing and supports
- Lifestyle modifications
- Bracing and orthotics
- Corticosteroid injections or medications
Surgical Options
You can ask your doctor about surgical procedures other than ankle replacement, including:
- Ankle fusion
- Distraction arthroplasty
- Joint preservation surgery
- Minimally invasive techniques
Risks and Complications of Ankle Replacement
Even if you are a suitable candidate for ankle replacement surgery, there are still some risks and complications associated with the surgery.
- Injection at the implant site: Infections can develop post-surgery at the site of the implant.
- Implant loosening or wear: The implant can loosen or wear as you lose/gain weight and perform activities.
- Nerve damage or numbness: Ankle replacement surgery can cause temporary or permanent nerve damage due to the proximity of nerves to the surgical area.
- Blood clots: after surgery, the leg is often immobilized, due to which the blood flow slows down, increasing the risk of blood clots.
- Limited range of motion over time: The range of motion stays limited over a time period after surgery.
- Need for revision surgery: Surgical procedures don’t always go as intended, and complications can occur, which can require a revision surgery.
How to Determine If You’re a Suitable Candidate
If you are not sure whether you’re a suitable candidate for ankle replacement surgery, some tests and consultations can help you determine.
Medical Evaluation and Imaging
You have undergone a comprehensive medical evaluation with your doctor. Your healthcare provider may have you take imaging tests, including X-rays, a CT scan, and a bone density test. These tests will help determine your bone condition and suitability for the surgery.
Discussion of Lifestyle, Occupation, and Mobility Goals
Your doctor or care consultant will ask questions about your lifestyle, including your occupation, hobbies, physical activity, smoking, and drug usage. It’s important to have an honest discussion with your doctor and outline your expectations of mobility clearly.
Review of Medical History
The doctor will check your medical history in detail to determine your suitability to become a candidate for an ankle replacement surgery. They will check for arthritis type, blood circulation, infection risk, and other conditions, such as neuropathy and diabetes.
Consultation With an Orthopedic Foot and Ankle Specialist
You can consult with an orthopedic foot and ankle specialist for a more detailed check-up and more comprehensive evaluation of your medical history, bone condition, and mobility goals. A surgeon will determine your suitability for surgery through personalized tests and diagnostic reports.
Recovery Expectations After Ankle Replacement
It’s important to set realistic recovery expectations when you are considering ankle replacement surgery. It’s a serious surgical procedure that aims to help with pain and stiffness, but you should realize that your range of motion or mobility may never be fully restored or become “normal” even if the surgery goes 100% well.
Moreover, before you walk into an operation room, take into account the entire process of going through a surgery, including hospital stay, dietary restrictions, non-weight-bearing protocols, and a complete recovery schedule. It’s also critical for some patients to perform follow-up imaging tests and consider post-operative physical therapy.
Key Takeaways
Ankle replacement surgery is often recommended by doctors when conservative or non-surgical treatment has shown no signs of effectiveness or improvement. However, not every patient is a good candidate for this surgery. It’s not recommended for people with smoking habits, neuropathy, uncontrolled diabetes, a physically active lifestyle, poor bone quality, a history of infections, or morbid obesity. To learn about comprehensive treatment and surgical options, understand more about your suitability for ankle replacement surgery, make an appointment with Dr. Gary Driver, an award-winning orthopedic foot and ankle specialist and surgeon.
Frequently Asked Questions (FAQs)
Can older adults get ankle replacement surgery?
Yes, older adults can get ankle replacement surgery as long as they are suitable candidates for a surgical procedure. However, doctors do not generally recommend ankle replacement surgery for older adults who are below 50 years of age.
Why is severe deformity a problem for ankle replacement?
Severe deformity is a problem for ankle replacement because it creates abnormal stress and uneven weight distribution on the prosthetic joint, increasing the risk of complications, including implant failure.
Is ankle fusion better for some patients than ankle replacement?
Ankle fusion is a common alternative to ankle replacement surgery, and it’s often a better option for some patients, especially younger and more active patients. It’s also a better option for those with poor bone quality and severe deformity.
What happens if you get ankle replacement despite not being a good candidate?
Getting ankle replacement despite not being a good candidate for the surgery may lead to significant complications and poor outcomes. The procedure is more likely to fail, potentially leading to increased pain and the requirement for further revision surgeries.
Can I get an ankle replacement after an ankle fusion?
Yes, you can get ankle replacement after an ankle fusion, but it's a really complex surgical procedure that doctors usually advise against unless absolutely necessary.
What lifestyle factors reduce your eligibility for ankle replacement?
Some lifestyle factors that reduce your eligibility for ankle replacement surgery include smoking, obesity, a sporty or highly active lifestyle, and an occupation that requires heavy labor or demanding physical activity.
How can I find out if I'm a candidate for ankle replacement?
You can take imaging tests (x-rays, CT scans, bone density tests), undergo a comprehensive medical evaluation, and have a detailed consultation with a reliable orthopedic foot and ankle specialist and surgeon to find out if you are a good candidate for ankle replacement.
