Name of the Procedure:

Arthroplasty, ankle; revision, total ankle
Common name(s): Total Ankle Replacement Revision, Ankle Joint Replacement Revision

Summary

Arthroplasty, ankle; revision, total ankle is a surgical procedure that aims to replace or repair a previously implanted artificial ankle joint that is no longer functioning properly. This surgery is typically performed when the initial ankle replacement has either worn out, failed, or caused complications.

Purpose

The procedure addresses issues related to a failed or problematic initial ankle replacement. The goals of the revision surgery are to reduce pain, improve joint stability and function, and enhance overall mobility.

Indications

• Persistent or worsening ankle pain
• Loosening or failure of the initial ankle prosthesis
• Infection of the original prosthesis
• Instability or deformity of the ankle joint
• Wear and tear of the original implant leading to malfunction

Preparation

• Fasting typically required 8-12 hours before surgery.
• Adjustments to current medications as advised by the surgeon.
• Preoperative imaging tests such as X-rays, CT scans, or MRI to assess the condition of the initial prosthesis and surrounding bone.
• Routine blood tests and possibly a preoperative physical examination.

Procedure Description

1. The patient is placed under general anesthesia or spinal anesthesia.
2. An incision is made over the original surgical site.
3. The surgeon carefully removes the failed or worn-out components of the initial ankle prosthesis.
4. The bone surfaces are prepared to accommodate the new prosthesis.
5. The new prosthetic components are implanted and secured.
6. The surgeon checks for proper alignment and stability of the new joint.
7. Incisions are closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 2 to 3 hours.

Setting

This surgery is performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Scrub Technician
• Radiologic Technologist (if imaging is needed during surgery)

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Prosthesis loosening or dislocation
• Bone fractures around the implant
• Anesthesia-related complications
• Persistent pain or stiffness

Benefits

• Relief from chronic pain
• Improved joint stability and function
• Enhanced quality of life through better mobility
• Correction of deformities or malalignments

Recovery

• Hospital stay of 2 to 3 days
• Pain management through medications
• Physical therapy starting soon after surgery
• Use of crutches or a walker initially
• Avoiding weight-bearing activities for several weeks
• Follow-up appointments to monitor healing and prosthesis function
• Full recovery typically takes 3 to 6 months.

Alternatives

• Conservative treatments such as physical therapy, ankle braces, or pain medications
• Ankle fusion surgery, which fuses the bones of the ankle joint to eliminate movement but provide pain relief
• Pros of alternatives: Less invasive options may require shorter recovery times.
• Cons of alternatives: May not provide the same level of pain relief or functional improvement as a revision surgery.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. After the procedure, there may be discomfort and swelling, managed through pain medications and ice packs. Physical therapy will be a critical component of recovery, and the patient will gradually regain mobility and strength in the ankle.