The operation begins by making an incision through the skin into the front of the ankle. This is called an anterior approach to the ankle. Once through the skin, the nerves and blood vessels are protected and moved to the side. The tendons are also moved to the side. The ankle joint is entered by making an incision into the joint capsule that surrounds the ankle joint. The surgeon can now look at the surfaces of the joint as he/she prepares the bone to replace the ankle joint surfaces.
Cutting the Bones
The next step in replacing the ankle joint is to cut the bones that make up the socket of the ankle joint--the tibia and the fibula--so that the metal socket will fit in place.
Next, the top of the talus is cut so the metal talar component can be inserted.
Inserting the Implant
All of the tibial implant and the talar implant portions of the artificial ankle joint are then inserted.
Bone graft is then placed between fibula and the tibia to create a fusion between the two bones. This stops the motion between the two bones that could loosen the joint replacement. The bone graft is taken from the bone that has been removed from the ankle earlier.
Inserting the Screws
Then the ankle is tested to make sure the pieces fit properly. To make sure that the ankle socket or the mortise component fits tightly, two screws are placed between the fibula and the tibia just above the ankle joint.
When the surgeon decides that everything is satisfactory, the ankle joint capsule is sutured back together and the skin is sutured together. A large bandage and splint are placed on the lower leg to protect the new ankle joint as your leg heals.
Closing the Incision
There are several ways that orthopaedic surgeons can close the incision after performing a joint replacement. Stainless steel staples are popular with many orthopaedic surgeons because they are easy to put in and easy to take out. This can reduce time in the operating room. The stainless steel staples are one of the most inert types of sutures, meaning they have a very low risk of allergic reaction in the patient.
Some surgeons prefer using sutures that dissolve on their own after several weeks. These stitches are normally put in just under the skin. The advantage of this type of closure is that you don't have to have your stitches taken out. Usually there are special tape closures (sometimes called "butterfly" tapes or "steri- strips") that are used to hold the edges of the skin closed for the first few days. If you see strips of tape across the incision, this is probably the type of closure that was done. This type of incision closure takes a bit more time in the operating room.
Finally, many surgeons still use the old "tried and true" nylon stitches one at a time. Nylon has withstood the test of time and is nearly as inert as stainless steel. It is strong and holds well until it is removed (somewhere between 2 to 4 weeks after surgery).
Other Surgical Procedures
Because ankle replacement implants must be aligned properly to function correctly, additional soft tissue surgeries may be required. These procedures can re-establish the proper ligament tension and ankle alignment required for proper range of motion and walking. Your surgeon can better explain the need for these surgeries based on your individual need.
Note: Please understand that the information above is provided for reference purposes only. Your surgeon may change any or all aspects of your treatment as discussed in this section based on his/her experience, preferences and your particular situation.