Dr. Harley’s Guide for Foot Care


Ankle Joint Replacement


Technological advances in ankle replacement are ushering in a new world of pain-free movement for people suffering from debilitating ankle arthritis. While once severely restricted in their activity, those who undergo ankle replacement can enjoy a complete turnaround and actively participate in life again.


According to the American College of Foot and Ankle Surgeons (ACFAS), innovative design and instrumentation, ankle replacement surgery-also called ankle arthroplasty-have vastly improved over the past decade or so, making it a fast-growing, highly successful solution today for those unable to walk without great pain.


"With contemporary arthroplasty, ankle arthritis sufferers who thought their situation was hopeless can get a new lease on life," says Brian Harley, DPM, FACFAS, a Fellow Member of the American College of Foot and Ankle Surgeons and surgeon at Northside Hospital in Cumming, Georgia. "For years they were told they'd always be in pain, but ankle replacement has totally changed their lives-they can now walk with ease, stop going to the pain clinic, and stop taking powerful opioid medications."


Ankle replacement surgery involves replacing a damaged joint with an implant (prosthesis) that serves as an artificial joint. The procedure, which is becoming the treatment of choice, provides important advantages over the historically standard technique off using the ankle joint.


"Although fusion eliminates pain and treats the arthritis, it often leaves the patient with a stiff leg and difficulty walking," says Dr. Harley. "Fusion also increases the likelihood of developing arthritis in the adjacent joints due to ankle immobility."


In contrast, ankle replacement surgery gets rid of the pain while also maintaining full range of motion. "It lets you walk with a normal gait and perform activities you couldn't do comfortably with a fusion. It also takes stress off the joints below and in front of the ankle, decreasing the risk of arthritis developing there."


Ankle arthroplasty is usually performed on people in their 40s through 60s, younger than typically seen with knee and hip replacements. Ankle arthritis is almost always caused by a previous injury. Often the injury was sustained as a teenager or young adult, and arthritis developed later.


One typical case at Dr. Harley’s practice is a 48-year-old male who was unable to walk without severe pain due to a severe ankle fracture from 10 years prior. “He could not perform normal daily functions without pain, but did not want the limitations that come with ankle fusion” according to Dr. Harley. “The surgery was successful and the patient returned to full activities, many of which he has not done in 10 years.”


The procedure is performed by making an incision in front of the ankle, removing the arthritic bone and cartilage, and inserting the implant. A state-of-the-art instrumentation guides the surgeon in making precise cuts in the bone. "More precise cuts mean tighter, anatomically fitting implants so they're less likely to be loosened or misaligned," explains Dr. Harley. Today's implants have a significant improvement over older designs and usually consists of two metal components and a plastic spacer that fits between those metal components.


During part of the recovery period, patients use crutches, a walker, or some other mobility aid to avoid putting weight on the ankle, generally between two to six weeks. It typically takes eight to ten weeks before the patient can wear a regular shoe. Physical therapy aids patients in gradually returning to full weight bearing in 6-8 weeks.


Although complications can occur with ankle arthroplasty, they are generally well-managed by a surgeon experienced in ankle replacement. In selecting a surgeon, Dr. Harley advises: "Look for a board-certified surgeon who is familiar with ankle reconstruction in general. Ankle arthroplasty often requires other reconstructive work, so the surgeon must be competent in other areas."


"Given the advances in this procedure and its life-altering benefits, ankle replacement surgery is certainly here to stay," says Dr, Harley. Clearly ankle arthroplasty is greatly improving lives-enabling previously pain-ridden people to easily walk, hike, take the kids to the park, or just stroll on the beach without pain, discomfort, or the need for opioid drugs.


-- Dr. Brian Harley

For more information on ankle replacement or Dr. Harley’s practice, call 770-667-4410. Dr. Brian Harley, DPM is double board certified in foot and ankle reconstructive surgery and has offices in Cumming and Alpharetta. His practice specializes in ankle joint replacements as well as sports medicine, trauma, and reconstructive surgeries of the foot and ankle.