Ankle joint replacement: all the secrets of the operation

The ankle is a complex joint that can lose its functionality over time. If the situation is serious enough, surgery and ankle replacement

. The essence of the method is to replace unusable parts of the joint partially or completely.

The ankle joint serves to connect the lower leg and foot. It is he who is responsible for the stability of the support, shock absorption when jumping, walking, loads, and the correct movement of the lower extremities. Thanks to the ankles, a person can walk on uneven and inclined surfaces, jump, and stand on his toes.

Modern endoprostheses

They are distinguished by high functionality, innovative materials and high-tech manufacturing methods. An artificial structure can completely replace damaged elements due to its structure being identical to a natural joint. This plays a decisive role in success. A prosthesis can last 15 years or more if installed and used correctly.

In what cases is endoprosthetics indicated?

The upper ankle joint, formed from the ankle joint itself, the tibia and fibula, is susceptible to arthrosis. In advanced stages, patients suffer from chronic pain and are unable to move normally. If conservative therapy fails, they are recommended to undergo upper ankle joint replacement. After operation:

the pain subsides;
gait normalizes, although it is impossible to completely restore mobility;
the patient can perform daily tasks again.

About 90% of patients are satisfied with the results of ankle replacement

What complications may arise

Negative consequences can be caused by non-compliance with the rules of behavior in the period after surgery, the characteristics of the patient’s body, and also arise due to incorrect actions of doctors. Possible problems include:

Difficult wound healing.
Fracture.
Infection, swelling, redness, suppuration at the wound site.
Blood clot formation.

Complications dealt with include:

Limited movement or loss of mobility.
Unstable implant position.
Immersion of implants into the bone.
Premature wear of the prosthesis.

Types of ankle arthrosis

Arthrosis of the ankle occurs not only due to age-related changes in the joints. It can be triggered by cartilage injury, sprained ligaments, valgus flatfoot, and rheumatism. Osteoarthritis is also caused by a crooked position of the leg axis, metabolic disorders, rheumatism and other pathologies.

There are several types of arthrosis of the ankle joint. Depending on its type, the patient is selected a suitable method of surgical intervention.

With concentric arthrosis, the talus bone is located in the center.
When eccentric, it is displaced.
There is also rear and front centering.
Valgus and varus arthrosis.

If the disease is accompanied by bone necrosis and has reached an advanced stage, endoprosthetics is pointless. Based on the diagnostic results, the doctor makes a decision, assesses the condition of the ligaments, the position of the hindquarters and arch of the foot: surgery is not always indicated and does not help everyone.

You need to seriously prepare for ankle replacement surgery.

Contraindications

Intervention cannot be carried out in a number of cases:

If there is inflammation in the joint area.
During periods of exacerbation of immune and other pathologies.
For acute infections.
With decompensation of blood flow in the lower extremities.
With severe deformation of joints.
For severe osteoporosis.
In the absence of an ankle.
With Charcot's disease.

The decision to perform an operation is made individually in the following cases:

Elderly patients.
Overweight patients.
For oncological diseases.
For mental disorders.
For other chronic pathologies.

The patient's condition is assessed and a decision is made on the advisability of surgical intervention. In any case, the potential benefit of the operation is weighed against the possible harm to the patient's health.

What are the treatment options?

For ankle arthrosis, the following types of joint replacement are practiced:

Installation of a titanium prosthesis with a movable polyethylene core. This option is suitable even if the cartilage is completely worn out. The technology of ankle replacement has greatly improved over the past 10 years and has gradually begun to replace the “gold standard” (arthrodesis).
Arthrodesis is therapeutic immobilization to relieve pain when putting weight on a joint. After surgery, gait is disrupted and the load on the hip and adjacent ankle joints increases. The rehabilitation period is at least 4 months. Arthrodesis comes to the rescue if endoprosthesis replacement is contraindicated.
Osteotomy is a modification of the talus and calcaneus so as to move healthy cartilage to the area of the main load and preserve the joint.

Which is better – ankle replacement or arthrodesis? The expert’s reasoning is in the video:

Technique for ankle replacement

Before undergoing surgery, patients in German clinics undergo an examination, which includes:

general examination;
examination of the musculoskeletal system;
X-ray examination;
ECG;
lab tests.

When planning surgery, doctors select implant segments using standard templates that are superimposed on an x-ray. Preparation for surgery consists of carrying out a series of physiotherapeutic procedures to improve blood supply, as well as applying special bandages that, after surgery, help maintain increased blood supply to the ankle area.

Ankle joint replacement is performed in compliance with all sterility rules. Proper preoperative preparation and selection of the optimal type of endoprosthesis can prevent possible postoperative complications.

The operation begins with the surgeon making an anterior incision along the ankle joint and pushing aside the vessels, nerves and tendons. He opens the articular cup and resects the destroyed parts of the joint, as well as the cartilage of the tibia and talus. After this, the removed tissue is replaced with artificial material.

Typically, such an operation in medical centers in Germany is performed under general or spinal anesthesia. Ankle replacement lasts less than an hour. In complicated cases, it can take about two hours.

Features of the modern approach to ankle replacement

During endoprosthetics, a small part of the talus is removed, and the cancellous bone tissue fuses with the surface of the endoprosthesis. The denser the bone, the more stable the prosthesis will be.

In recent years, the possibilities of endoprosthetics have expanded, and surgical methods for treating osteoarthritis have become more progressive. Orthopedic surgeons resort to accompanying measures for improved fixation of the prosthesis. These include correction of the support, plastic surgery of the tibial collateral and external ligaments, refixation and tightening of ligaments, and other operations that improve stability in a standing position, with maximum load on the prosthesis. Similar events are carried out several months before endoprosthetics.

In order for the prosthesis to last as long as possible, at the preparatory stage, surgeons eliminate deformations resulting from accidents and injuries. The more deviations of the axis from the norm, the faster the wear of the prosthesis will occur. Therefore, doctors strive to correctly align the hindfoot and get rid of deformities.

Department of Traumatology and Orthopedics

article in PDF format

DOI: 10.17238/issn2226-2016.2018.1.40-45 UDC 617.3 © Mikhailov K.S., Bulatov A.A., Pliev D.G., Sorokin E.P., Guatsaev M.S., 2018

K.S. Mikhailova, A.A. Bulatov, D.G. Pliev, E.P. Sorokin, M.S. Guatsaev

FSBI Russian Research Institute of Traumatology and Orthopedics named after. R.R. Vreden" Ministry of Health of Russia, St. Petersburg, 195427, Russia

summary:

Purpose of the study: To analyze the immediate and long-term results of ankle joint replacement surgery. Material and methods: An analysis of the treatment results was carried out in 71 patients who underwent HS endoprosthesis surgery in the period from 2003 to 2014, who were divided into two clinical groups. Results: No signs of instability of endoprosthetic components were observed in any of the 31 patients during the first year of observation. However, two years after surgery, 6 (19.4%) patients showed signs of aseptic instability of various components of the endoprostheses. During the study of long-term results of HS endoprosthetics, in 16 (40%) of the examined patients, radiological signs of aseptic instability of the components of the installed endoprostheses were noted. Conclusions: HA endoprosthetics operations in the absence of unsatisfactory outcomes provide good or satisfactory treatment results in the vast majority of patients examined: 100% according to VAS and 96% according to the AOFAS scale – after 2 years; 100% on both scales – after 3 years; 92.3% – after 5 years and 85.7% – after 7 years after surgical treatment. At the same time, the dynamics of the various studied indicators were generally similar, but also had some differences.

Key words none: ankle joint, deforming arthrosis of the ankle joint, arthroplasty of the ankle joint, risk factors for unsatisfactory treatment outcomes.

THE RESULTS OF ANKLE JOINT ARTHROPLASTY WITH THIRD GENERATION MODELS PROTHESIS

Mikhaylov KSA, Bulatov AA, Pliev DG, Sorokin EP, Guatsaev MS

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, 195427, Russia

summary:

e purpose: e aim of this study was to make a comparison in patients who underwent ankle arthroplasty in short and long term follow up period. Material and methods: We evaluated the eciency of ankle joint replacement (71 patients). All patients were divided into 2 groups – prospective (6, 12 and 24 months) and retrospective (3, 5, 7 and 10 years). e results were evaluated with the help of a visual analogue scale (VAS) and the 100-point AOFAS scale; we also performed x-ray examinations. e longest follow-up period was 10 years. Results: there were no signs of instability of the endoprosthesis components in any of the 31 patients during the first year of follow up. However, two years a er surgery in 6 (19.4%) patients showed signs of aseptic instability of the various components of the implants. Also we identified a signi cant risk factor for the most frequent complication, which was aseptic instability of the implant components. Conclusion: TAR in the absence of unsatisfactory results provide good or satisfactory results of treatment in the vast majority of patients: 100% for VAS and 96% on a scale of AOFAS – 2 years; 100% on both scales – 3 years; 92.3% a er 5 years and 85.7 percent – 7 years a er operative treatment. e dynamics of the di erent studied parameters were generally similar but had some di erences.

key words: ankle joint, arthrosis of the ankle joint, ankle arthroplasty, risk factors.

Introduction

Currently, special attention is paid to the surgical treatment of patients with deforming arthrosis of the HS of various etiologies [1,2,3,4]. This attention is determined, first of all, by the high incidence of this pathology, which affects approximately one in 500 adults, pain syndrome, significant functional impairments, as well as treatment results, which are not always satisfactory for operated patients [5,6,7].

In patients with this pathology, operations of two main types are used - arthrodesis of the arterial joint, which remains the “gold standard” for surgical treatment of this category of patients, both in our country and throughout the world [8,9,10,3]. The second rapidly developing method was ankle replacement [2,11,12].

It should be noted that while for HS arthrodesis the risk factors for postoperative complications and indications for choosing this method of surgical treatment have already been developed and tested in clinical practice over a long period of time, for HS arthrodesis they are still under development.

It is relevant to analyze the immediate and long-term results of ankle joint replacement surgery. Purpose of the study: to analyze the immediate and long-term results of HS endoprosthesis operations using the third generation of endoprosthesis models.

Materials and methods

The study included 71 patients who underwent HS endoprosthesis surgery in the period from 2003 to 2014. The examination was carried out up to two years after surgery (31 patients) in a prospective group, as well as long-term outcomes studied after 3, 5, 7 and 10 years (40 patients) in a retrospective group. First of all, the stability of the installed implants was assessed based on radiological and clinical criteria. Then, a subgroup of patients without signs of aseptic loosening of the endoprostheses was identified and the immediate treatment outcomes were assessed over time, comparing them with the data obtained in patients with affected joints before surgery. The treatment outcomes of patients with developed instability of endoprosthetic components were assessed separately and their risk factors for this pathological condition were identified.

All patients underwent an X-ray examination, which included x-rays of the feet in two projections, a questionnaire using the VAS and AOFAS scales.

An X-ray examination carried out before surgical treatment showed that the majority of patients had late stages of deforming arthrosis of the HS according to the classification of JH Kellgren et al (1957) [13] (Table 1).

results

Signs of instability of endoprosthetic components were not observed in any of the 31 operated patients during the first year of observation.

However, two years after surgery, 6 (19.4%) patients showed signs of aseptic instability of various components of the endoprostheses. Corresponding radiological signs included: the appearance of radiolucent lines and a zone of overload sclerosis at the bone-implant interface, as well as cyst-like reconstruction of the bone tissue around the implanted structures (Fig. 1).

Clinical and functional indicators were studied in patients without complications at 6, 12 and 24 months after surgery. The means are summarized in Table 2.

Examinations of patients showed that already 6 months after surgery, the severity of pain syndrome significantly (P<0.05) decreased by an average of more than 6 points on a visual analogue scale. Subsequently, 12 and 24 months after surgical treatment, the average values of this indicator gradually decreased from 2.2±0.2 to 1.8±0.2 points. Similar dynamics were demonstrated by indicators on the AOFAS scale. By six months, the functional capabilities of the operated HS significantly (P<0.01) increased more than threefold (from 25.0±2.0 to 79±3.7 points). Further, by the two-year period, the values of this indicator did not change significantly.

In addition, we conducted a qualitative assessment of the results of surgical treatment of 25 patients without complications two years after HS endoprosthetics using well-known assessment criteria - VAS and AOFAS scales

It should be noted that the results of the qualitative assessment on both scales used were almost identical. The vast majority of patients two years after surgery had good (56–60%) or satisfactory (40%) treatment outcomes. The severity of the pain syndrome significantly decreased and the functionality of the operated joints significantly increased.

The good clinical result obtained in the prospective group two years after HS arthroplasty is illustrated by clinical observation (Figure 2-3).

The function of the left HS was restored almost completely after two years (Fig. 3.)

In the course of studying the long-term results of endoprosthesis replacement, in 16 (40%) of the examined patients, radiological signs of aseptic instability of the components of the installed endoprostheses were noted, which had a significant impact on the severity of pain and the functionality of the operated limbs. Therefore, all patients were divided into two subgroups: without this complication (24 people) and with signs of its presence (16 people). It should be especially noted that the proportion of patients with unsatisfactory outcomes turned out to be so high (40%) because they deliberately applied to the institution where they underwent HS endoprosthetics. Patients with good treatment outcomes refused to undergo examination in the long-term period after surgery. Therefore, the actual share of unsatisfactory results considered could be significantly less.

As a result of the X-ray examination, signs of instability were revealed (Fig. 4 a, b).

5 years after HS endoprosthetics, 23 patients were examined and 10 (43.5%) cases of implant instability were identified. Aseptic instability of both components of the endoprostheses was diagnosed (Fig. 5).

During the analysis of the results of surgical treatment 7 years after endoprosthesis replacement, 8 patients operated on in 2005–2008 were examined. In one of them (12.5%) with a Star endoprosthesis installed (Waldemar Link), aseptic instability of both components of the endoprosthesis was revealed. However, it should be noted that in 13 (56.5%) of 23 patients examined after 5 years, as well as in 7 patients examined 7 years after surgery, the studied radiographs showed good secondary fixation of the components of the installed endoprostheses without signs of their loosening and instability (Fig. 6), as well as the absence of corresponding complaints.

10 years after HS endoprosthetics, three patients operated on between 2003 and 2005 were examined. In two of them, a slight angular migration of the tibial component of the installed Star endoprosthesis (W. Link) was revealed without signs of progression (Fig. 7).

Despite the presence of small focal cyst-like reconstruction of the bone tissue around the implants, the position of the endoprosthetic components remained correct and stable. At the same time, in all patients, the clinical and functional indicators of the operated joints at the time under discussion were considered good or satisfactory.

It should also be noted that in the majority of the examined patients (24 out of 40 or 60% of observations) there were no signs of pathological changes in bone tissue and signs of instability of the installed structures in the period from 3 to 10 years after the operations. The obtained radiological data complement the results of our clinical and functional studies, which are presented below.

When assessing the studied clinical and functional indicators in the long-term period after HS endoprosthetics, it was found that the values of the visual analog pain scale at the first follow-up examination were significantly lower compared to their preoperative level. Thus, 3 years after surgery, the average VAS value corresponded to 2.2±0.3 points (Table 3). When observed after 5 years, the value on this scale was 2.4±0.4 points, and after 7 years it increased to 2.6±0.5 points.

We observed a similar trend for AOFAS scores. 3 years after surgery, its average value corresponded to 79±3.5 points, at follow-up after 5 years – 76±3.2 points, and after 7 years this value was 73±3.32 points.

Thus, it was found that in the period from 3 to 10 years after surgery there was a uniform but slight increase in the severity of pain syndrome according to VAS and a moderate (7.6%) decrease in the score on the AOFAS scale.

The analysis of changes in the functional state of operated HS in the period from 3 to 10 years after surgical treatment showed, on average, good scores on the VAS and AOFAS scales in patients without unsatisfactory outcomes. After 5 years, in 76.9% of patients, the average value on the VAS was 2.4±0.4 points, and on the AOFAS scale – 76±3.2 points, which corresponds to the assessment category “good”.

Moreover, both of these indicators differed for the better by more than three times compared to the corresponding preoperative values.

Discussion of the results obtained

HS endoprosthetics operations in the absence of unsatisfactory results provide good or satisfactory results in the vast majority of patients examined: 100% according to VAS and 96% according to the AOFAS scale – after 2 years; 100% on both scales – after 3 years; 92.3% - after 5 years and 85.7% - after 7 years. At the same time, the dynamics of the various studied indicators were generally similar, but also had some differences.

In particular, the severity of pain in the area of the operated joint, assessed by VAS, was minimal 2 years after surgery and gradually increased thereafter, reaching a maximum at the ten-year follow-up period. The functional capabilities of the GS, determined by the AOFAS scale, reached the maximum average values in points already 6 months after surgical treatment, remained at this level until three years, and then gradually decreased over the next 7 years. The amplitude of movements in the GS (flexion/extension) increased after endoprosthetics by an average of only 40 and reached the maximum average values, corresponding to approximately 75% of the norm, after 6 months.

However, it should be especially noted that in the examined patients, without signs of aseptic instability of the installed HS endoprostheses, the average values of the studied indicators (except for range of motion) 10 years after the operations were significantly better (P<0.05) than the preoperative values.

The above results of our research generally coincide with similar data from the specialized scientific literature. In particular, it is known that an analysis of the outcomes of the use of the Hintegra HS endoprosthesis (NewDeal) over a period of one to 5 years showed an increase in the AOFAS score on average from 40.3 to 85.0 points [14]. Another publication presents the results of using the Mobility endoprosthesis (De Puy) in 233 patients at an average follow-up of 32.8 months [15]. It was noted that after installation of this endoprosthesis, joint function improved on the AOFAS scale from an average of 48.2 to 84.1 points, and pain syndrome according to VAS regressed from an average of 7.7 to 1.7 points. However, the range of motion in the operated joints improved by an average of only 2.1° (from 19.8° to 21.9°), which is quite consistent with our data.

Studies have shown that aseptic instability of various components of HS endoprostheses is a common unsatisfactory outcome of operations [16]. In particular, it occurred in 6 (19.4%) of 31 patients in the prospective group at the two-year follow-up period after the operations. It should be noted that in 5 (83.3%) of 6 such cases, this pathology was observed in patients aged 40 to 54 years who had a history of fractures of the distal metaepiphysis of the tibia, ankles or talus, as well as high functional loads on GS.

The information we obtained generally coincided with that provided by other researchers. Thus, according to various foreign authors, the proportion of patients with aseptic instability of the components of HS endoprostheses varies from 3% to 13.7% in the first 5 years after operations [17,18] and from 16% to 32% in periods from 5 to 10 years after such surgical treatment [19,18].

It should be noted that in the presence of radiological signs of aseptic instability of HS endoprostheses, a decrease in the functionality of the operated joints (according to the AOFAS scale), as well as an increase in the intensity of the pain syndrome (according to the visual analogue scale) have significant individual differences. Therefore, patients with aseptic instability did not always agree to undergo reoperation, which involved removal of implants and arthrodesis of the arterial joint. Such revision operations were performed in only one (16.7%) of 6 patients in the prospective group and in 7 (43.8%) of 16 patients in the retrospective group. The majority of patients with aseptic instability of the components of installed endoprostheses preferred to preserve the installed implants.

The facts described above indicate that radiological signs of instability of the GS components do not always have pronounced clinical manifestations. In our opinion, this feature explains the wide dispersion in the figures of the unsatisfactory results discussed in the publications of various authors. It should also be noted that the work took into account precisely the radiological signs of aseptic instability of the installed implants, which determined the rather high percentage of patients with such negative results.

Particular attention in our study was paid to identifying risk factors for the development of aseptic instability of HS endoprostheses. The following factors were identified: the young (up to 55 years) age of the patients and the associated high functional loads on the operated joints, as well as deformations of the tibia and talus, forming the articular surfaces of the joint, resulting from previous injuries. However, the analysis showed that the risk factor for the development of this condition is not so much the presence of a history of GS injuries, but rather the existing deformities of the tibia and talus.

It should be especially noted that in the specialized literature there are publications indicating a direct connection between the development of aseptic loosening of HS endoprostheses and reasons such as severe deformations of the articular surfaces of the tibia and talus [20,3,21], as well as young age and high physical activity patients, determining increased functional loads on the operated joints [22,23,24].

List of references/References

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Author information  

Mikhailov Kirill Sergeevich – candidate of medical sciences, junior researcher at the scientific department for the treatment of injuries and their consequences; doctor, traumatologist-orthopedist, traumatology and orthopedic department No. 19, Russian Research Institute of Traumatology and Orthopedics named after. R.R. Harmful" of the Russian Ministry of Health. e-mail, tel. +7-921-958-0458).  

Bulatov Alexander Anatolyevich – Candidate of Medical Sciences, doctor of the traumatology and orthopedic department No. 19 of the Russian Research Institute of Traumatology and Orthopedics named after. R.R. Harmful" of the Russian Ministry of Health.

Pliev David Givievich – Candidate of Medical Sciences, Head of the Scientific Department of Hip Pathology, Federal State Budgetary Institution Russian Research Institute of Traumatology and Orthopedics named after. R.R. Vreden" of the Ministry of Health of Russia, head of traumatology and orthopedic department No. 19.

Sorokin Evgeniy Petrovich – candidate of medical sciences, senior researcher at the scientific department for the treatment of injuries and their consequences; doctor, traumatologist-orthopedist, traumatology and orthopedic department No. 7, Russian Research Institute of Traumatology and Orthopedics named after. R.R. Harmful" of the Russian Ministry of Health.

Guatsaev Maxim Soslanovich – laboratory assistant-researcher of the scientific department of pathology of the hip joint; doctor, traumatologist-orthopedist, traumatology and orthopedic department No. 19, Russian Research Institute of Traumatology and Orthopedics named after. R.R. Harmful" of the Russian Ministry of Health.

Information about authors

Mikhaylov Kirill S. – Cand. Sci (Med), researcher, Vreden Russian Research Institute of Traumatology and Orthopedics. e-mail

Bulatov Aleksandr A. – Cand. Sci (Med), Vreden Russian Research Institute of Traumatology and Orthopedics, department No. 19.

Pliev David G. – Cand. Sci (Med), researcher, head of department No19, Vreden Russian Research Institute of Traumatology and Orthopedics.

Sorokin Evgeniy P. – Cand. Sci (Med), researcher, Vreden Russian Research Institute of Traumatology and Orthopedics.

Guatsaev Maksim S. – researcher, Vreden Russian Research Institute of Traumatology and Orthopedics.

Funding: The study had no sponsorship.

Funding: e study had no sponsorship.

Conflict of interest: The authors declare no conflict of interest.

Con ict of interests: e authors declare no con ict of interest.

For quotation:

Mikhailov K.S., Bulatov A.A., Pliev D.G., Sorokin E.P., Guatsaev M.S., RESULTS OF ANKLE JOINT ENDOPROSTHETICS WITH THE THIRD GENERATION OF ENDOPROTHESHES MODELS // Department of Traumatology and Orthopedics. 2021.No1(31). With. 40-45.

How modern ankle endoprostheses work

Previously, patients had metal prostheses installed that did not adhere well to cement and did not give the desired result. Today, orthopedic surgeons use only third-generation prostheses, which completely fuse with the bone and are securely fixed, providing the joint with natural biomechanics.

A special metal cover is placed on the talus bone.
The surface of the tibia is covered with a metal plate.
The third component of the prosthesis is a freely moving polyethylene core.

You will be able to drive a car no earlier than 2 months after surgery.

Prosthetic options

The first generation of implants were artificial devices consisting of two parts. They were cemented in place. The cement could be squeezed out beyond the boundaries of the implant, so the bone was heavily resected to avoid this. Then, in the practice of endoprosthetics, the same prostheses began to be used, but with cementless fastening.

Currently, 3 types of implants are used in medical practice:

connected;
unrelated;
half-tied.

Such prostheses may include two or three components. Depending on the device of the implant, it has different methods of fixation:

in the form of long or short legs;
in the form of ribs;
with bone cement;
cementless.

Currently, in Germany, doctors use the most modern artificial ankle joint replacements for prosthetics. The most common are implants made of ceramic or alloyed cobalt-chrome alloy with a special coating that ensures safe fixation.

The latest generation of total implants are durable, lightweight, comfortable and stable. These artificial ankle replacements do not interfere with walking, playing sports, or driving. They consist of three components:

rounded covering on the head of the talus;
a metal plate to cover the lower flat end of the tibia;
the core is made of polyethylene, allowing the other two components to movably rest on each other and not slide off.

Thanks to this design, the implant reliably protects all lines of mutual contact and movable interactions of the ankle.

How is the operation performed?

Endoprosthesis replacement is performed under general or local anesthesia. The patient lies on his back. The leg is tightened with a cuff to prevent the flow of blood (if the operation is protracted). To obtain an instant image, the surgeon uses a mobile X-ray device under a sterile coating, which allows you to monitor the progress of the operation and the localization of the prosthesis.

The surgeon makes an incision along the front of the joint and extends it down to the back of the foot.
The tendons above the joint are moved to the side.
The joint capsule is opened and part of the bone tissue is removed to get a good view.
Using an X-ray machine and special instruments, the axis and position of the hindfoot for implantation are determined.
The talus is covered with a metal cap (there are metal pins inside it that allow movement).
The surface of the tibial joint is covered with a protective metal plate, and both components are also covered with a special layer for reliable fusion of the bone tissue.
A movable sliding core is installed.

After endoprosthetics, the patient spends 5-7 days in the hospital

Progress of surgery

In accordance with the traditional technique, arthrodesis of the ankle joint is performed under general anesthesia in an open manner. The procedure lasts 2-3 hours.

A tourniquet is applied to the lower third of the thigh. A scalpel is used to make a linear incision 10 cm long along the joint.
The joint is opened and rotated.
The surfaces of the talus and tibia are prepared. Cartilaginous tissue is resected using a surgical chisel and ossification is removed.
The foot is moved out of the wrong position. The talus and tibia are articulated with each other in a physiologically comfortable position. Fastened with metal devices.
Soft tissues are sutured layer by layer and drainage is installed.

In case of severe deformity, osteotomy of the fibula is used. Loss of bone tissue is replaced with grafts - biological material that is taken from the patient. If external fixation systems (Ilizarov apparatus) are used, plaster casting is not required. When using internal metal implants, a cast is placed on the limb. The rate of bone fusion depends on the individual characteristics of the patient. Complete fusion occurs after 3-6 months.

Arthroscopic arthrodesis is performed using an arthroscope through small incisions. The method is characterized by low tissue trauma, a quick rehabilitation period, and reduced risks of complications. Surgery is performed under spiral anesthesia or general anesthesia.

The surgeon removes hyaline cartilage and articular parts. The foot is placed in a neutral position and secured with screws. The first screw connects the talus and tibia, the second - the talus and fibula. After the operation, the incisions are sutured, the wounds are covered with bandages, and immobilization is provided.

Is it possible to play sports with a prosthetic ankle?

After endoprosthetics, the patient is given a number of restrictive recommendations. The most important thing is to avoid lifting weights over 20 kg. It is advisable to wear special shoes that will provide stability when walking, especially at first. During the recovery period, physiotherapeutic procedures and lymphatic drainage may be prescribed.

At the end of the recovery period, as a rule, the following is allowed:

ski;
swim;
ride a bike;
jog;
go trekking;
to play golf.

After endoprosthetics, you will have to forget about football, tennis or high-speed slalom

Postoperative rehabilitation

In the postoperative period, it is recommended to limit the load, for which a plaster splint, crutches (no more than 1-2 weeks) or a fixator are used. After the stitches are removed, the patient undergoes an active rehabilitation program, including various types of exercise therapy, physiotherapy and other measures aimed at reducing swelling and restoring motor functions. If you follow the recommendations of a rehabilitation doctor, within two months patients fully recover and return to their usual active life.

Return to section: Joint arthroscopy

What are the forecasts?

Despite the latest operating technologies, the prognosis is not very encouraging. In 90% of cases, the prosthesis lasts no more than 8 years. Repeated operations are performed infrequently - only in 6-8% of cases. This means that after this time the patient will again experience pain and remember limited mobility.

There are also complications after endoprosthetics. The wound over the new prosthesis does not heal quickly, the lower leg swells, suppuration, the formation of blood clots and thrombosis are not uncommon. Sometimes the prosthesis spontaneously loses its fixation, sags and wears out unexpectedly quickly. Therefore, experienced doctors recommend that patients think carefully before deciding to undergo surgery. In many cases, you can get rid of pain and restore joint mobility with the help of a synovial fluid prosthesis, without surgery.

Indications for surgery

Arthrodesis of the ankle joint is prescribed when the following pathologies are detected:

primary arthrosis of 3-4 degrees;
post-traumatic arthrosis;
severe chronic arthritis;
constant pain in the joint that gets worse with light loads;
lameness caused by joint deformation;
limitation of flexion-extension movements;
violation of the supporting ability of the foot, looseness;
paralysis of the lower leg muscles due to polio;
improper healing of the fracture.

With the help of surgical intervention, persistent pain is eliminated and motor function is restored after prolonged limitation.