Five questions on total ankle arthroplasty

For the Monitor
Published: 6/18/2020 8:20:35 AM

What is total ankle arthroplasty?

Total ankle arthroplasty, or total ankle replacement, is a surgical procedure designed to help relieve pain and maintain motion for patients with advanced arthritis of the ankle. A surgeon removes arthritic cartilage and part of the ankle bones and replaces them with metal and plastic components.

What other treatment options are available?

The principal treatment for ankle arthritis is diet and exercise.  Initially, physicians treat ankle arthritis with non-surgical options including medication, physical therapy, injection, and bracing the ankle to try to limit painful movement. If those conservative approaches are not effective, surgical options such as ankle fusion or total ankle arthroplasty are available. 

What is ankle fusion?

Ankle fusion, or arthrodesis, surgery has been the gold standard surgical treatment for ankle arthritis, which most often is caused by injury such as a sprained or fractured ankle. The surgery consists of permanently “fusing” together the bones of the ankle joint using plates and screws with a host of available techniques. While ankle fusion relieves pain, it limits motion in the ankle, meaning other nearby joints take on the shock absorbing role of the ankle and those joints may degrade over time.

What type of total ankle arthroplasty is available?

There have been three generations of ankle replacement technology and there are currently several FDA approved implants.  The device I discussed is called the Scandinavian Total Ankle Replacement (STAR). Compared to earlier designs, STAR mobile bearing design minimizes stress transfer to the implant to maximize implant longevity and involves a surgical technique that minimizes ankle bone resection.  By maintaining range of motion, nearby joints are likely spared from taking on additional stress. Patients typically return to regular activities several months after the procedure, though surgeons generally recommend low-impact activities to prolong the life of the implant. 

Why is the ankle such a difficult joint to treat?

The ankle is a complex joint that absorbs substantial amounts of stress over a small surface area. Taking a step transfers five to seven times a person’s body weight to the ankle – running: 10 to 15 times the weight.  A successful implant must include precise alignment to withstand these loads, without damaging the remaining bone in the ankle or putting extra stress on nearby joints. The replacement procedure itself is complicated because, unlike the knee or hip, the ankle joint is very small, offering a smaller field of vision for the surgeon, a very limited amount of bone can be removed without dramatically weakening the joint, a smaller amount of bone that can be paired with the implant, and a complex blood flow.

Who is a candidate for the total ankle replacement procedure?

As ankle implants and the techniques have improved, more patients are becoming candidates for total ankle arthroplasty.  Surgeons experienced with these procedures can evaluate your condition and whether you may benefit from this surgery.  

(Dr. Christopher Gentchos is a board-certified orthopaedic surgeon specializing in foot and ankle surgery. He joined Concord Orthopaedics and Concord Hospital’s medical staff in 2007 and cares for patients at the Orthopaedic Institute at Concord Hospital. Dr. Gentchos recently presented on Total Ankle Arthroplasty at the June Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Gentchos’ presentation on Concord Hospital’s YouTube channel at


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