What is it?
In a total ankle replacement, the worn joint surfaces of the shin bone (tibia) and ankle bone (talus) are removed and replaced with metal components. A smooth plastic bearing sits between them so the ankle can still move. Ankle replacement is one of Mr Jeyaseelan's special interests: he trained with the design surgeons of a widely used ankle replacement during his fellowship in Vancouver.
Who might it help?
- Advanced ankle arthritis, whether from wear and tear, a previous injury or inflammatory arthritis
- Pain that still limits daily life despite non-surgical treatment
- An ankle with reasonable alignment, bone quality and ligament stability
- People who want to keep movement in the ankle rather than have it fused
Is it right for you?
Treatment is tailored to your individual needs, symptoms and goals. Surgery is only recommended when it is likely to help, and non-surgical options are always discussed first.
Mr Jeyaseelan will talk you through the benefits, risks and alternatives for your situation at your consultation.
What does it involve?
- It's done under a general or regional anaesthetic, usually with a stay in hospital of one to three nights.
- The ankle is reached through a cut at the front. The worn surfaces are removed and the new components fitted.
- If the foot or ankle is out of line, other procedures may be needed at the same time to correct it and balance the ligaments.
Before your operation
- You'll have a pre-assessment check, usually a week or two before surgery, including blood tests if needed
- Stop smoking, ideally at least six weeks before, as it slows bone and wound healing
- Arrange help at home for the first couple of weeks, and someone to take you home
- Prepare your home: clear walkways, and put everyday things within easy reach
- If you'll use crutches or a knee scooter, practise beforehand
On the day
- You'll be asked not to eat or drink for a few hours beforehand
- The anaesthetist will discuss the anaesthetic with you, often a general anaesthetic with a nerve block to keep the foot numb for several hours afterwards
- Mr Jeyaseelan will see you before the operation to answer any questions and mark the leg
- Before you go home, you'll be shown how to use crutches and given pain relief and written instructions
Recovery
You'll usually be in a plaster or boot for around six weeks, with your weight bearing increased gradually as advised. Physiotherapy then helps restore movement, strength and walking. Swelling commonly takes six to twelve months to settle fully.
Foot raised most of the time, in a plaster or boot, using crutches. Wound check at about two weeks.
In a boot, gradually increasing weight bearing as advised. Gentle movement exercises.
Out of the boot into supportive shoes. Physiotherapy to restore movement, strength and walking.
Steady improvement. Swelling settles gradually, and most people return to low-impact activities such as walking, cycling and golf.
These times are typical only. You'll be given a personal recovery plan.
Getting back to normal
- Driving
- You can usually drive once you're out of a boot and can do an emergency stop safely. After right-foot surgery this is often six to eight weeks or more. Check with your insurer.
- Work
- Desk-based work is often possible after two to six weeks if you can keep the foot raised. Jobs that involve standing or walking take longer.
- Sport
- Low-impact exercise, such as cycling and swimming, usually comes first. Running and contact sport come later, once strength and movement have returned.
- Flying
- Long-haul flights are usually avoided for at least six weeks after foot and ankle surgery because of the risk of blood clots. Ask before booking travel.
Possible risks
As with any operation, there are risks. They include:
- Infection or problems with wound healing
- Damage to nearby nerves or blood vessels
- Blood clots in the leg or lungs
- A break in the bone around the implant
- Ongoing pain or stiffness
- Wear or loosening of the implant in the future, which may need further surgery
Alternatives
Non-surgical options include activity changes, pain relief, supportive footwear, braces and joint injections. For some ankles, an ankle fusion is the better operation. Mr Jeyaseelan will compare replacement and fusion honestly for your ankle.
Mr Jeyaseelan also performs revision surgery for ankle replacements that have become painful or worn.
Conditions this may treat
Common questions
Where can I have total ankle replacement in London?
Mr Lucky Jeyaseelan, a consultant orthopaedic surgeon who specialises only in the foot and ankle, sees private and insured patients with problems that may need total ankle replacement at Align Orthopaedics on Harley Street, The London Clinic on Devonshire Place, HCA London Bridge Hospital, HCA UK at The Shard, HCA UK City of London on Old Broad Street and The Holly Hospital in Buckhurst Hill, Essex. See all clinic locations or request an appointment. If surgery is right for you, he will discuss which hospital suits you best.
How long is recovery after total ankle replacement?
You'll usually be in a plaster or boot for around six weeks, with your weight bearing increased gradually as advised. Physiotherapy then helps restore movement, strength and walking. Swelling commonly takes six to twelve months to settle fully. Your own recovery plan will be tailored to you.
Is it covered by health insurance?
Mr Jeyaseelan is recognised by major insurers including Bupa, AXA Health, Aviva, Vitality and WPA. Cover depends on your policy, so please get an authorisation code from your insurer before your appointment.
Do I need a GP referral?
Self-funding patients can book directly, though a GP letter is helpful. Most insurers need a GP referral before they authorise your consultation, so check with yours first.
This information is general and is not a substitute for a medical consultation. Your diagnosis and treatment plan will be tailored to you.