Complete Ankle
Replacement (CAR)

Complete Ankle Replacement (CAR)

A complete Ankle replacement surgery may be required for those patients who are suffering from unbearable ankle pain due to arthritis. In this surgery, the damaged parts of the 3 bones that make up the ankle joint are taken care of to improve the movement of ankle joint in the affected patient.

An Ankle replacement Surgery to replace the ankle joint with an artificial one is becoming quite common these days. Although it is not undertaken as frequently as the replacement of the knee or hip joints, yet, if required, it is very effective in reducing the pain experienced due to ankle arthritis. New progress in the blueprint of the synthetic ankle and improvements in the methods of performing operations have given a new dimension to complete ankle replacement, and a growing number of people are turning towards this option to get rid of the constant suffering inflicted upon them due to ankle arthritis.

Anatomy of an Ankle Joint…

Made up of 3 bones: the lower end of shinbone (called tibia), small bone of lower leg (called fibula), and the bone that fits into the socket formed by tibia and fibula (called talus). Sitting right on top of heel bone, talus primarily moves in only one direction, allowing the feet of the person to move up and down. To hold this bone arrangement at its place, there are ligaments on both sides of the ankle joint to hold the bones together.

While the ligaments connect the bones, the tendons are there to hold the muscles in body. One such tendon happens to be the large Achilles tendon, which is located at the back of the ankle. It is indeed the strongest tendon in the foot, and joins the calf muscles to the heel bone and provides the feet with the required strength to move, walk and run.

What necessitates a CAR?

There are clear signs related to a particular condition of the ankle that may prompt an Orthopaedic Surgeon to consider an Ankle replacement Surgery. There could be several reasons behind the arising of such a condition of the ankle joint like, osteoarthritis of the ankle, Bone spurs or outgrowths, or even a physical injury to the ankle caused by an accident.

The Artificial Ankle…

Every artificial ankle used for replacement is primarily made up of 2 parts…

The tibial part (to replace socket of ankle at the top section).
The talus part (to replace the talus at the top section).

The decision to use a special epoxy cement to join the metallic parts of the artificial joint to the bone is entirely at the discretion of the Orthopaedic Surgeon, who might or might not use it according to the condition of the joint. Some Orthopaedic Surgeons favor placing the artificial joint without any cement. The surface of this kind of prosthesis has a very intricate mesh of cavities that let bones to grow through it and join the prosthesis to the bone.

The Operation…

First of all the patient is given general anesthesia or a spinal type of anesthesia, which puts the patient to sleep on the operating table.
Now the surgeon makes an incision on the front skin of the ankle to access the ankle joint. Cutting through the skin, the surgeon does the job of separating the nerves & blood vessels, and moving them along with the muscles to one side to make way into the joint capsule enclosing ankle joint.
Now the surgeon works on the end of ankle bones to place the metal socket in its place. At last, all the various parts of artificial ankle joint are now placed in their position, and the Surgeon tests the ankle to ensure that everything has fitted properly.
To ensure ankle sockets (the tibial part) have fitted properly, 2 metallic screws are inserted passing through fibula and tibia right on top of the artificial ankle joint.
Bone is spliced between fibula and tibia to make a joint. This restricts any movement between the 2 bones that could slacken the artificial joint. The bone splice is taken from the bone that was detached from the ankle previously in the splicing procedure.
Once the surgeon gets satisfied with the fittings and their proper placements, he proceeds to close the cut with stitches. Normally, more than one layer of stitches is employed beneath the skin, and metal staples are also put to use to close the cut on the skin. Finally a bandage is put on the stitched cut, and the patient is taken back to the recovery room for rehab.