When a person is experiencing pain that comes from bone grinding on bone in the ankle, there are a few treatment options that are available. One of the more radical procedures, though also one of the most effective, is a complete replacement of the ankle joint. Called an ankle arthroplasty, it becomes a treatment option when decreased functionality and chronic pain occur within the joint.
Only you and your medical provider can decide if an ankle arthroplasty is the right form of treatment to meet your needs. While discussing the matter, you may wish to include these pros and cons into the conversation.
What Are the Pros of Ankle Arthroplasty?
1. It provides a complete treatment option when there is no cartilage.
People will eventually wear out their cartilage for a number of reasons. Trauma to the ankle joint helps to facilitate this process. Over time the combination can create the bone on bone mechanism that causes so much pain and may even lead to the development of arthritis. By replacing the ankle joint in its entirety, it becomes possible to remove the painful conditions that exist so that activities can be resumed.
2. There is instant pain relief from the joint issue.
Although there is often extensive recovery time and pain associated with the ankle arthroplasty, there is instant pain relief from the joint issue that required the surgery. As the recovery time passes, people who have this surgery often find themselves being more active and mobile than they can remember being in several years. Although highly active people are counseled to keep their joints, additional movement after no movement is a good thing.
3. It eliminates the possibility of a limp that may occur from an ankle fusion.
People who have ankle troubles may be recommended for an ankle fusion instead of a total replacement. This stiffens the ankle joint, but it tends to loosen up the surrounding areas. Even so, it is not uncommon for a limp to develop because of the stiffness of the affected ankle. A total replacement eliminates this issue because there is more flexibility and natural movement available within the joint. A fusion prevents side to side and up and down motions, while the replacement still allows for this to some extent.
4. Even if there are tibial stability issues, a fixed implant may still offer relief options.
Not every total ankle replacement needs to have a flexible joint. There are also replacement options which offer a fixed joint instead. Because it is easier to insert and offers adaptability options for the sometimes unpredictable nature of the surgery, there are fewer overall complications that typically occur, sometimes even compared with an ankle fusion.
5. Recovery periods for a total replacement are often shorter than for a fusion.
Although the recovery time for a complete replacement can be extensive, they are still better than what a fusion procedure typically requires. In return, a restoration of the biomechanics of the ankle is typically achieved. That’s a risk many are often willing to take even though there is the risk for more overall complications after the surgery when compared to a fusion. The biggest temptation, in fact, is to start weight bearing on the new joint before enough healing has occurred.
6. It provides a treatment option for severe damage.
Even though an ankle fusion might be recommended for many people seeking a total replacement, the ankle arthroplasty provides a treatment option when extensive damage to the joint has occurred.
What Are the Cons of Ankle Arthroplasty?
1. It doesn’t generally help the people who want the help.
There are two key issues that are often addressed when considering a complete ankle replacement. The first is a person’s activity levels and the second is their weight. People who weigh 250+ are often considered poor candidates because the weight on the joint is believed to wear it out more quickly. Those who are active and young tend to not receive a recommendation either for similar reasons.
2. Many of the replacement joints fail within 20 years of installation.
A study that originated out of Finland shows that 20% of all ankle replacements will fail within two decades of the ankle arthroplasty. The most common reasons for this are joint instability, loose components within the replaced joint, or joint movement seizing up. New designs are believed to be more durable, but there is no long-term information available on the latest technologies. It could be that current replacements are just as durable as their older counterparts.
3. There are some serious side effects of the surgery that are fairly common.
Even skilled surgeons find that they may cause inadvertent injuries during the installation of the new joint. Bone fractures that happen at the installation site are especially common, while injuries to the nerves or tendons around the area may also occur. Blood vessel damage is also a complication of the replacement surgery. Some folks don’t even have their joint heal into the bone, requiring a follow-up surgery.
4. The surgery can be costly and it may not be covered by insurance.
The issue here is whether or not the consulting doctor believes that a patient is a good candidate for an ankle replacement. If someone is active, has a high BMI, or other concerns that are strikes against them, the decision for a surgery may not be covered by a health insurance plan. Because a total replacement surgery may cost upwards of six figures, not everyone can afford the procedure if it isn’t approved for coverage.
5. There are certain risks that are associated with every surgery.
Whether it is from the general anesthesia, the chances of an infection, or the chance of bleeding out, there are always personal risks assumed when going under the knife. Ankle arthoplasty procedures are highly reliable thanks to current medical technology, but there is always a chance that the procedure will not be as helpful as believed. The health risks are enough that waivers are often signed before the procedure acknowledging that the medical procedure is not 100% guaranteed to work.
6. For some people, it is a temporary solution.
An ankle fusion is a permanent solution to an ankle solution. A total replacement is actually a temporary solution for many people as they’ll outlive the lifespan of the installed joint.
The pros and cons of an ankle arthroplasty show that it is a viable treatment option, but still may not be right for everyone. Speak with your medical provider about your personal activity levels, your medical history, and your plans post-op. This, along with this list of key points, will let you know whether or not a total replacement procedure is right for you.