Which patients are suitable for artificial total ankle replacement?
The main indications for artificial total ankle arthroplasty are
1, rheumatoid arthritis, ankle pain and very poor residual function;
2.Ankle pain and degeneration of the ankle joint;
3.The bone quality of the talus is still good and the stability of the ligaments around the ankle joint is intact;
4.Inside/outside deformity less than 10°;
5.Hindfoot deformity can be corrected.
Ankle joints with intractable pain and ankles with degenerative changes but sufficient stability are indications for the use of ankle prosthesis. Rheumatoid arthritis is a common indication for surgery, but most predominantly traumatic arthritis, accounting for 42% of cases. In patients with ischemic osteonecrosis of the talus with collapse, a bone graft is required to support the prosthesis during surgery. Previous ankle fusion can now be replaced by total ankle replacement instead of ankle fusion.
Post-operative rehabilitation plan for ankle arthroplasty.
(a) Ramses ankle prosthesis post-operative rehabilitation plan
Month 1
1. Gradually return to full weight-bearing with a fixed splint. Start walking with double crutches, then use single crutches;
2. Active/passive ankle flexion/extension exercises under non-weight-bearing condition.
Month 2
1. Remove the fixed splint and use ankle brace. Full weight-bearing without crutches;
2.Active/passive ankle flexion and extension exercises under weight-bearing condition;
3.Gait exercises;
4.Proprioceptive exercises.
Month 3
1.Continue to use the ankle brace;
2.Strengthen the active and passive flexion and extension exercises under weight;
3.Proprioceptive exercises and inversion exercises;
4.Gait exercises and motor coordination exercises.
At the end of the 3rd month
Remove the ankle support and move the ankle joint freely.
(II) Rehabilitation program after S.T.A.R. total ankle joint replacement
After surgery, the ankle joint was kept in a neutral position with a sub-knee splint. 2 days later, the drainage tube was removed, the wound was changed and immobilized with a short tubular cast of the lower leg. The lower extremity of the operated side was elevated for two days. Full weight bearing was then allowed. The patient was asked to walk for up to 10 minutes at a time with full weight-bearing on one lower limb. The lower extremity on the operated side alternates weight bearing and rest in this manner.
The American advocates 6 weeks of postoperative immobilization in a sub-knee tubular cast in a neutral ankle position. The cast may be removed after 4 weeks for ankle osteoarthritis and 6 weeks for ankle rheumatoid arthritis. After removal of the cast, the patient was instructed to walk, and the physical therapist instructed ankle mobility and balance training. After two days intermittent weight-bearing walking for 10 minutes, the cast was removed after 3 to 4 weeks (non-cemented fixation), with attention to the exercise of the foot muscles and the posterior calf muscles. The ankle joint may be swollen 3-6 months after surgery and can be intermittently fixed with an elastic bandage or intermittent elevation of the affected limb.
In Germany, if bone cement is used, the external fixation should be removed after 14 days. If bone cement is not used, the external fixation must be retained for 3 to 4 weeks. After removal of the mold, the patient is recommended to perform heel-to-toe squatting exercises. Patients should also perform standing exercises on tiptoe to strengthen the muscles of the lower extremity.
The ankle surgical area may be swollen for 3 to 4 months. During this time, patients usually experience painful pulling after exercises or in the evening. The use of elastic stocking covers and elevation of the lower extremity on the operated side can be helpful in relieving pain. Symptoms that remain after 12 months postoperatively are permanent.