As a rule, osteoarthritic and inflammatory changes in the ankle joint are the starting point for progressive joint destruction (ankle osteoarthritis). Eventually, mobility is often so severely limited that joint replacement becomes necessary—doctors refer to this as ankle arthroplasty. This procedure is offered at specialized centers.
Certification as an Endoprosthetics Center (EPZ)
Physicians who hold this seal are affiliated with medical facilities that are certified by endocert as an Endoprosthetics Center (EPZ) or as a Maximum Care Endoprosthetics Center (EPZmax) and have thus demonstrated through an audit that they meet the established requirements. Recertification is required every three years.
You can find the criteria, requirements, and differences between EPZ and EPZmax here.
What exactly is ankle osteoarthritis?
Ankle osteoarthritis does not develop overnight. It is usually the result of decades of improper stress on the joint. As a result, joint wear increases and the joint surfaces are destroyed by inflammation.
When the bone surfaces that form the joint rub directly against one another, this causes severe pain. In the ankle joint, this results in a significant restriction of movement at an early stage.
The following conditions affecting the ankle joint contribute to osteoarthritis:
- Bone-cartilage trauma, i.e., blows or impacts to the joint, e.g., as a result of competitive sports,
- ligament instability, causing the joint to have too much mobility,
- Leg misalignments, such as bowlegs or knock-knees,
- asymmetry in the position of the talus relative to the ankle joint,
- Changes in the foot arch, such as flat feet or fallen arches,
- rheumatism,
- Joint hemorrhages associated with hemophilia
- Metabolic disorders, such as diabetes mellitus or gout,
- bone fractures and associated ligament injuries.
Osteoarthritis is an irreversible form of joint degeneration. Depending on the extent of the damage, however, its progression can be slowed, or—at the end of what is usually a long and painful ordeal—an ankle joint replacement may become necessary.
What are the advantages of ankle replacement surgery?
The prosthesis is usually made of titanium with a movable core of polyethylene. This typically allows the ankle joint to retain its mobility. Joint fusion in the ankle area (= ankle arthrodesis), on the other hand, is not an option, as it impairs not only the rolling motion of the foot when walking but also the body’s posture. In the worst case, this in turn can lead to further joint diseases and improper weight-bearing.
Often, unbearable pain in the ankle joint is the necessary prerequisite for the implantation of an ankle prosthesis. And indeed, the pain will improve rapidly after surgery and appropriate rehabilitation. Furthermore, the joint replacement helps maintain a normal gait, which further reduces pressure on the joint itself.
Patients with ankle replacements generally have much better mobility than before surgery and are able to participate more actively in life again.
Although the artificial joint will never match the range of motion of a natural ankle joint, the degree of improved mobility is entirely sufficient for normal walking in everyday life. Surveys also show that, thanks to new techniques and prosthetic materials, up to 90% of patients with ankle replacements are now satisfied.
How do specialists in ankle joint replacement perform the surgery?
The ankle joint prosthesis is surgically implanted under general or local anesthesia. The patient lies on their back during the operation. Typically, blood flow in the affected leg is restricted using a thigh cuff, allowing the procedure to be performed with reduced blood flow.
When is an ankle replacement not an option?
However, a new ankle joint should not be implanted in the following cases, e.g.:
- in cases of immunosuppression,
- in cases of active infections
- in cases of joint necrosis,
- problems with body awareness,
- in cases of high stress on the joint, e.g., due to obesity or excessive athletic activity.
How long do joint replacements last?
It is also particularly important for patients to know how long these joint prostheses will actually last. According to the Swedish Joint Replacement Registry, the timing of implantation appears to be a key factor. Joint replacements implanted between 1993 and 2005 lasted at least five years in 78% of patients and up to ten years in 62%. Within the first five years, 19% of the artificial joints required reoperation and replacement.
Today, prosthetic design in ankle replacement surgery is already significantly more advanced than it was 20 years ago, so much longer durability can be expected.
Furthermore, the surgeon’s level of experience is of considerable importance to the success of the operation. For an experienced specialist in orthopedics and trauma surgery, 30 procedures are considered a minimum threshold.
