Q: I’m dealing with unbearable ankle pain. I can’t walk, run, ride my horse, or even keep up with my grandkids. I’m so desperate that I’ve even thought about having my foot amputated. I asked my surgeon about getting a joint replacement, but they said it was too ‘experimental.’ I know others are getting this surgery. What do patients who have had it say about their results? If the feedback is good, I’m determined to find someone who will do it.
A: Total ankle replacement is indeed a complex and challenging procedure, often associated with complications that might require additional surgeries. However, for some patients, it is a viable option and can be an acceptable alternative to ankle fusion—or even, as you’ve considered, amputation.
The procedure has evolved significantly since the first attempts in the 1970s. The implants have been redesigned and improved, leading to what are known as second-generation implants. While these newer implants have shown better results, the outcomes are still not perfect.
Most patients who undergo total ankle replacement report improvements in motion and function. Walking typically becomes easier, although running might not be possible for many. However, residual pain can still be a problem after surgery, and complications such as infections (both superficial and deep in the joint) can occur.
Studies indicate that up to one-third of patients experience surgical failure, meaning the implant may need to be removed. Common reasons for this include implant loosening, fractures of the implant, and subsidence (where the implant sinks into the bone).
Longevity is also a key concern. Ideally, the implant should last 10 to 15 years, but long-term studies are just now starting to show results with these second-generation implants.
Surgeons are very selective about who they recommend for this procedure. There could be specific reasons why your surgeon feels you aren’t a good candidate. However, it’s also possible that your surgeon doesn’t specialize in total ankle replacements.
It might be worth seeking a second opinion from a surgeon who frequently performs this type of surgery. If you get the same response, then it could be beneficial to explore other pain management options that could help improve your functionality. There might be conservative treatments that you haven’t yet tried that could make a significant difference in your quality of life.
Reference: James A. Nunley, MD, et al. Intermediate to Long-Term Outcomes of the STAR Total Ankle Replacement: The Patient Perspective. In The Journal of Bone and Joint Surgery. January 4, 2012. Vol. 94A. No. 1. Pp. 43-48.