Question 1

How long will my ankle replacement last?

Accepted Answer

Modern ankle replacements have 75-85% SURVIVAL at 10 YEARS, 60-70% at 15 YEARS. This means 75-85% of patients still have their original implant functioning at 10 years, but 15-25% required revision surgery (implant replacement or conversion to fusion). COMPARISON TO HIP/KNEE: Ankle replacement survival LOWER than hip (90-95% at 10 years) or knee (90-92% at 10 years) replacement - ankle joint smaller, higher loads per unit area, less forgiving to malposition, more technically demanding surgery. AGE CONSIDERATIONS: (1) Age 70-80 years: Implant likely to outlast patient (90%+ chance implant lasts patient's lifetime given life expectancy 10-15 years). (2) Age 60-69 years: 50-70% chance implant lasts lifetime depending on activity level (low-demand higher chance). (3) Age 50-59 years: HIGH likelihood revision needed (75-85% need revision within lifetime if implant only lasts 10-15 years). (4) Age under 50 years: Almost CERTAIN to need revision (multiple revisions possible - NOT RECOMMENDED for young patients). FAILURE MODES (why replacements fail): (1) ASEPTIC LOOSENING (40-50% of failures): Metal components loosen from bone without infection - causes pain, instability. Due to implant micromotion, osteolysis (bone resorption around implant). (2) POLYETHYLENE WEAR (20-30%): Plastic insert wears down, loses thickness, causes instability and osteolysis. Accelerated by high activity, malalignment, heavier patients. (3) SUBSIDENCE (10-20%): Implant sinks into talus bone (talar component most common) - talar bone soft, difficult to get solid fixation. (4) INFECTION (5-10%): Deep infection requires implant removal, fusion typically required as salvage. (5) INSTABILITY (5-10%): Ligament insufficiency or component malpositioning causes ankle instability. ACTIVITY EFFECTS ON LONGEVITY: Walking only - implant may last 15-20 years. Golf, swimming - 12-18 years. Heavy walking, hiking - 10-15 years. Running, jumping - 5-10 years or LESS (NOT ALLOWED).

Question 2

Can I run or do high-impact activities after ankle replacement?

Accepted Answer

NO - running and high-impact activities are PERMANENTLY RESTRICTED after ankle replacement. This is CRITICAL to understand before consenting to surgery. PROHIBITED ACTIVITIES: (1) Running (jogging, sprinting). (2) Jumping sports (basketball, volleyball, tennis). (3) Contact sports (rugby, soccer). (4) High-impact aerobics, jumping exercises. (5) Heavy manual labor (construction, landscaping, loading/unloading). (6) Activities with repetitive impact loading. WHY RESTRICTED: (1) Polyethylene wear - high-impact activities cause rapid wear of plastic insert, leading to early failure. (2) Aseptic loosening - impact forces exceed implant-bone interface strength, causes micromotion and loosening. (3) Implant fracture - excessive loading can fracture metal components or plastic insert. (4) Subsidence - repetitive impact drives implant deeper into bone. Violating activity restrictions SHORTENS implant lifespan from 10-15 years to 5-10 years or LESS. Revision surgery required earlier. ALLOWED ACTIVITIES: (1) Walking unlimited distances on level ground or mild hills. (2) Stairs (easier than fusion - have some ankle motion). (3) Golf (allowed - low impact, rotational forces tolerable). (4) Swimming, water aerobics. (5) Cycling (stationary or road - no mountain biking off-road). (6) Elliptical trainer, cross-trainer (low impact). (7) Yoga, pilates (gentle stretching, low impact). (8) Light hiking on even trails (avoid rocky/uneven terrain). (9) Bowling, fishing, light gardening. COMPARISON TO ANKLE FUSION: Fusion allows HEAVIER activities once healed (can do some manual labor, more vigorous hiking) but NO running/jumping either. Replacement requires MORE caution with activities than fusion. If you MUST return to high-impact activities or heavy manual labor, ankle FUSION better choice than replacement (more durable for high loads, though still cannot run effectively with fused ankle).

Question 3

What happens if my ankle replacement fails - can it be revised?

Accepted Answer

Ankle replacement REVISION (replacing failed implant with new implant) is POSSIBLE but DIFFICULT and less successful than primary replacement. Success rate 60-70% at 5 years (vs 75-85% for primary replacement at 10 years). REVISION SURGERY CHALLENGES: (1) BONE LOSS: Removing failed implant leaves bone defects. Often significant bone missing from talus and tibia. Bone grafting required (autograft from iliac crest or allograft from bone bank). Larger implants or custom components may be needed. (2) SOFT TISSUE PROBLEMS: Revision through old scar tissue, multiple previous incisions increase wound complications (10-20% wound problems vs 5-10% primary). (3) INFECTION RISK HIGHER: Revision infection rate 3-5% vs 1-3% primary. If infected, implant must be removed, treated with antibiotics, fusion typically required. (4) LIGAMENT DEFICIENCY: Multiple surgeries may damage or stretch ankle ligaments, causing instability. Ligament reconstruction may be needed with revision. REVISION OPTIONS: (1) REVISION TO LARGER ANKLE REPLACEMENT: Insert larger implant to span bone defects. Use bone graft to fill voids. Success 60-70% at 5 years. May be able to revise 1-2 times before bone stock inadequate. (2) CONVERSION TO ANKLE FUSION (arthrodesis): Most common salvage after failed ankle replacement (50-60% of revision cases). Fuse ankle in fixed position using internal fixation + bone graft. Fusion rate 70-80% (lower than primary fusion 85-90% due to poor bone quality, previous surgery). Eliminates pain but loses motion. (3) HINDFOOT FUSION NAIL: Tibiotalocalcaneal fusion using intramedullary nail - fuses ankle AND subtalar joint. Reserved for severe bone loss, multiple failed revisions. Very disabling (entire hindfoot rigid) but reliable pain relief. (4) BELOW-KNEE AMPUTATION: Last resort if infection cannot be eradicated, severe bone loss, multiple failed revisions. Rare (less than 5% cases). MOST COMMON OUTCOME: Failed ankle replacement → conversion to ankle fusion. Patient ends up with fused ankle (outcome could have had with primary fusion, avoiding replacement complications and cost). This is why patient selection critical - if young active patient likely to outlive implant, fusion may be better primary choice.

Medical Disclaimer

Total Ankle Replacement

📖What is Total Ankle Replacement?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention