The total ankle replacement procedure is typically performed for patients who have arthritis. Two common types of arthritis that can be treated with a total ankle replacement are osteoarthritis and rheumatoid arthritis. Ankle joint replacement procedures are increasingly becoming a more popular treatment as the joint replacements are being associated with less complications. Surgeons will discuss all the possible complications of the specific type of ankle replacement about to be performed, with patients prior to the surgery day.
Fractures
According to the 2010 article in the "Journal of Orthopaedic Science" by Dr. Kyung Tai Lee of Eulji Hospital in the Republic of Korea, fractures can occur at either the medial or lateral malleolus of the ankle joint following joint replacement. The medial and lateral malleolus are the inside and outside bony prominences of the ankle. These fractures can occur as a result of placing the hardware, or after the hardware is placed, due to stress, resulting in a stress fracture. Even with a well surgically placed total ankle joint, patients can still fracture any of the bones of the ankle. This is known as a periprosthetic fracture where the bone breaks around the joint replacement.
Wound Healing
Healing at the surgical site can be impaired in some individuals with diseases such as diabetes or peripheral vascular disease, although wound site infections can happen in any patient. It usually takes a few weeks for the incision site to heal. Proper wound care as dictated by the surgical care team is important to help reduce the risk of delayed healing.
Infection
Infection is a risk of any surgery. When any type of surgical hardware is placed in the body, there is an increased risk for infection. Infection can occur from the surgery itself, or as a long-term post-operative complication. Some physicians advocate that patients take prophylactic antibiotics prior to dental cleanings and procedures to reduce the risk of bacteria getting into the blood and infecting the joint replacement.
Malalignment and Impingement
During surgery, the joint replacement can be place in a malaligned position, or there can be a site where structures are impinged upon by other structures as a result of the surgery. These complications lead to post-operative pain. Surgeons take x-rays and closely examine the joint in the operating room to try to prevent these complications.
Neurovascular Injury
Injuries can occur during the surgery to the nerves and blood vessels that course on their paths near the ankle joint. Nerve injury can lead to symptoms of numbness and tingling in various distributions of the foot. There can also be some intrinsic weakness in the toes due to nerve injury. Vascular injury can occur if there is either stretching of the vessels, or direct trauma to the vessels.
Reflex sympathetic dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS) can occur after total ankle arthroplasty. The extremity can develop a burning pain, stiffness, discoloration, or swelling.
Long-term Hardware Complications
Ankle replacements are subject to normal wear with time. The polyethylene lining can wear down. There can also be loosening of the components over time. When the components loosen, patients can may need to have the components replaced.
References
- "American Journal of Roentgenology"; Postoperative evalustion of the total ankle arthroplasty. Dr. Joseph Bestic et al; 2008.
- "Journal of Orthopaedic Science"; Perioperative complications of the MOBILITY total ankle system: comparison wiht the HINTEGRA total ankle system; Dr. Kyung Tai Lee et al; 2010
