27702 Arthroplasty, ankle; with implant (total ankle)

Name of the Procedure:

Arthroplasty, ankle; with implant (total ankle)

• Common Names: Total Ankle Replacement, Total Ankle Arthroplasty
• Technical Terms: Ankle Arthroplasty with Implant

Summary

Total ankle arthroplasty is a surgical procedure to replace a severely damaged ankle joint with an artificial implant. It aims to restore mobility and relieve pain caused by arthritis or injury.

Purpose

• Addresses severe arthritis or injury in the ankle joint.
• Goals:
  • Relieve chronic pain
  • Restore ankle function and mobility
  • Improve the patient’s quality of life

Indications

• Symptoms such as chronic ankle pain, swelling, stiffness, or decreased mobility.
• Conditions:
  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-traumatic arthritis
• Criteria:
  • Severe joint damage unresponsive to conservative treatments (e.g., physical therapy, medications).
  • Patients typically aged 50-75, relatively healthy, and active.

Preparation

• Pre-procedure Instructions:
  • Fasting (usually from midnight before the surgery)
  • Adjustments to medications (e.g., anticoagulants)
  • Smoking cessation
• Diagnostic Tests:
  • Blood tests
  • Imaging studies (X-rays, MRI)
  • Pre-operative physical examination

Procedure Description

1. Anesthesia administration (general or regional).
2. Incision made on the front of the ankle.
3. Removal of damaged bone and cartilage.
4. Placement of the artificial implant, typically made of metal and polyethylene.
5. Adjustment and alignment of the implant to ensure proper fit.
6. Closure of the incision with sutures or staples.
7. Application of a sterile dressing and possibly a splint or cast.

Duration

Typically takes 2 to 3 hours.

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians
• Postoperative Care Team

Risks and Complications

• Common Risks:
  • Infection
  • Blood clots
  • Nerve damage
• Rare Complications:
  • Implant loosening or failure
  • Fracture during or after surgery
  • Persistent pain or stiffness
• Management:
  • Treat infections with antibiotics
  • Manage blood clots with anticoagulants
  • Follow-up surgeries for complications

Benefits

• Pain relief typically within weeks after surgery.
• Improved ankle function and mobility within months.
• Enhanced quality of life and ability to perform daily activities.

Recovery

• Post-procedure Care:
  • Pain management with medications
  • Keeping the leg elevated and immobile initially
  • Physical therapy starting after a few weeks
• Recovery Time:
  • Initial recovery: 6 to 12 weeks
  • Full recovery: up to 6 months
• Restrictions:
  • Weight-bearing restrictions initially
  • Avoid high-impact activities
• Follow-up Appointments:
  • Regular check-ups to monitor healing

Alternatives

• Non-surgical options:
  • Physical therapy
  • Medications (NSAIDs, corticosteroids)
  • Ankle braces or orthotics
• Other surgical options:
  • Ankle fusion (arthrodesis)
• Comparison:
  • Total ankle replacement provides better mobility but may have a higher risk of complications than ankle fusion.

Patient Experience

• During the Procedure:
  • Under anesthesia, so no awareness of the surgery.
• After the Procedure:
  • Pain and swelling initially, managed with medications.
  • Possible use of crutches or walker.
  • Gradual increase in activity and physical therapy.
• Pain Management:
  • Analgesics and anti-inflammatory medications.
  • Ice packs and elevation for swelling.