Total Ankle Replacement (TAR) Center of Excellence

The ankle, or tibiotalar joint, is made up of three bones — the tibia, talus, and fibula. In a healthy ankle, the bones are cushioned by cartilage. But in an ankle with arthritis, the cartilage can wear away, leaving the bones to rub together painfully.

During a TAR, our expert team of orthopedic foot and ankle surgeons replaces the worn, painful structures of the ankle joint — the eroded cartilage — with three artificial implants. The surgeons reconstruct the ankle joint, attaching a metal component to the tibia and talus with a plastic spacer between them. These new parts allow the ankle to function much better and more comfortably.

A good candidate for an ankle replacement is someone with severe ankle arthritis but who wants to retain flexibility and mobility. A TAR can decrease pain and improve joint function.

Ankle fusion (arthrodesis) surgery can relieve ankle pain but is less successful than TAR at preserving mobility. During an ankle fusion, surgeons fuse the ankle bones together with a combination of screws, plates, and bone grafts—locking the ankle joint in place and limiting the ankle’s range of motion. Patients spend eight to 12 weeks in a cast, so recovery is longer.

While TAR is the preferred treatment for those with severe ankle pain, some situations are more appropriate for ankle fusion. These include very young patients for whom replacements may not last their entire lifetime and patients who have lost important bones or have nerve damage. Patients with reduced foot sensation due to neuropathy or other conditions are also better candidates for ankle fusion surgery.

Our team of TAR surgical experts helps determine the right treatment for each patient based on overall health, age, and activity level.

The TAR surgical experts at MUSC Health are experts at identifying and designing a treatment plan for ankle pain. They carefully consider important factors, including a patient’s pain level and loss of function, to help determine the need for replacement surgery.

Causes of damage

Ankle pain due to arthritis is often caused by previous injuries, including bone fractures, an infection or tumor, osteoarthritis (arthritis from wear-and-tear), and rheumatoid arthritis (arthritis from inflammatory conditions).

Conditions and symptoms of arthritis

• A constant pain while walking or standing
• Pain around the front of the ankle
• Ankle joint pain and persistent swelling
• Stiffness in the ankle joint
• Inability to bend your ankle while driving, going downstairs, etc.

Until recently, TAR was an inpatient procedure requiring a hospital stay. Thanks to improved surgical techniques, TAR is now offered as an outpatient procedure. Most patients go home on the same day as their surgery.

Ankle replacement is performed under regional anesthesia. Most patients receive a nerve block that lasts at least 72 hours. The surgery takes about two hours and results in a small, approximately 5-inch scar at the front of the ankle. Once patients recover from surgery and can safely walk with crutches, they can go home. Most patients use pain medications to control the pain for the first few days.

The first two weeks of recovery

A splint or cast keeps the ankle stable and immobile. Patients must keep their legs elevated to reduce swelling and are not to put any weight on them for two weeks. We recommend patients have someone at home with them during this time to ensure their safety and best outcomes. A family member, friend, or neighbor “coach” can help guide the patient through recovery by helping with meals and tasks and ensuring they have essentials. A “coach” is also important for helping to keep spirits up.

Beyond two weeks

At the two-week follow-up visit, patients can discard the splint and start walking with the support of a protective walking boot for the next four weeks. At six weeks, patients can remove the boot and begin recommended physical therapy. At eight weeks, most patients can wear normal shoes and begin limited activity.

Six months after surgery, most patients are 90% recovered. Patients can generally return to sports and other activities within six months to a year.

Thanks to exceptional advancements in surgical techniques, tools, and implant designs over the last decade, surgeons have vastly progressed in preserving ankle motion and improving a patient’s walk and gait. Significant innovations include enhanced implant materials that allow the ankle bones to grow into the implant for a longer-lasting result and a stronger spacer. Surgical instruments are also more accurate and reliable. Surgeons can now remove minimal bone to allow for future revision or refurbishment surgery.

Ankle replacement surgery is usually covered by insurance. Its success rate is 85% to 90% at ten years and 75% at 15 years. Depending on a patient’s age at the time of surgery, an ankle implant may eventually need to be replaced or revised.

Even the most active patients benefit from the increased mobility, reduction in pain, and restored function a TAR provides.