New Ankle Replacement Techniques Reduce Invasiveness and Enhance Outcomes

With baby boomers aging, look around an outdoor festival, and you’ll see plenty of what look like the walking wounded. You’ll see older adults who are walking as though they need a hip or a knee replaced. But, what about an ankle?

For people living with chronic ankle pain from severe arthritis, especially after past injuries or fractures, daily life can become a painful, frustrating struggle. But for the right candidate, a total ankle replacement can offer not just pain relief, but a chance to walk, shop and move through life again with ease.

Though it's been around for decades, total ankle replacement is still relatively unknown compared to hip or knee replacements. That's largely because until recently, the results weren’t great. Early generations of implants often failed, leaving surgeons hesitant and patients skeptical.

Technology has advanced in the last 10 to 15 years with custom, patient-specific metal implants. Bryce Paschold, DPM, a foot and ankle surgeon for OSF HealthCare/OrthoMidwest, says the process now requires less invasive bone removal, and outcomes are dramatically better.

“We put a poly [ultra-high molecular weight polyethylene] in between there [the replacement joint], and that’s the thing that allows for the motion between the joint,” Dr. Paschold explains. “So, basically we’re resecting out bone from both sides of the joint, which is getting rid of the arthritis, to preserve motion.”

Who is it for?

Not everyone is a candidate. Surgeons consider a person’s age, activity level, bone health and medical conditions such as diabetes or neuropathy before recommending the procedure.

The “ideal” patient? Someone older with significant pain and mobility issues who has already tried conservative treatments including braces, physical therapy, injections or modified activity.

“You want to do all those things first, for sure, because some people can do ok with just that,” Dr. Paschold point out. “But once you get through all that and the pain is still too severe. It shouldn’t be debilitating. It shouldn’t be life-altering. You don’t want to live life like this. Then surgery is a great option for the right patient.”

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What to Expect

The procedure is done under general anesthesia, often with a nerve block within the operative leg to reduce pain for the first 24 hours. Dr. Paschold says it will require a hospital stay.

”People will stay overnight one or two nights, typically just for pain control and for physical therapy so we can see them and get them kind of moving. Make sure they can get around safely without putting weight on the operative ankle side.”

For the first six weeks, expect to use crutches or a scooter. After that, physical therapy begins and continues for several weeks to restore strength and mobility. Driving is off the table for a while — especially if the right ankle is involved. Patients typically can’t drive for six to 10 weeks, depending on which side was operated on.

Full recovery takes about six months, but most people are walking and using the ankle well before that. Dr. Paschold says his patients do feel immediate relief, even if full recovery takes a while.

“Right away, most people are happier just because they have less pain. But the people I’ve done this one on, once they get through everything, they’re really happy because they can function and they can walk and go to the grocery store, go shopping without the pain that kept them down before.” He adds, “So they’re happy they can function and do daily living activities and feel like a normal person again.”

How Long Do Ankle Replacements Last?

The latest studies show promising longevity:

• 90% of implants still function well at 10 years
• 80% at 15 years
• 60% at 20 years

That’s a big leap from previous generations of implants and puts ankle replacements much closer to their hip and knee counterparts in terms of durability.

While running might not be the goal, especially for older patients, walking pain-free with a natural gait often feels like a miracle. Whether you're dealing with ongoing ankle pain or wondering if surgery is in your future, the message is clear: don’t wait. Get evaluated. You might be a candidate for a surgery that could transform your mobility and your life.

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