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Total Ankle Replacement – TAR Procedure Explained

Total ankle replacement is a surgical procedure that replaces a damaged ankle joint with an artificial implant. It relieves pain and preserves mobility in severe ankle arthritis.

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Things worth knowing about "Total ankle replacement"

Total ankle replacement is a surgical procedure that replaces a damaged ankle joint with an artificial implant. It relieves pain and preserves mobility in severe ankle arthritis.

What is Total Ankle Replacement?

Total ankle replacement (TAR), also called total ankle arthroplasty (TAA), is a surgical procedure in which the damaged upper ankle joint is replaced with an artificial implant. The ankle joint connects the lower leg bones (tibia and fibula) to the talus bone of the foot and is essential for walking, standing, and climbing stairs. When the joint cartilage is severely destroyed, a total ankle replacement can significantly reduce pain and greatly improve a patient's quality of life.

Indications – When is the Procedure Performed?

Total ankle replacement is typically recommended when conservative treatments such as physiotherapy, pain medication, and orthotic insoles no longer provide adequate relief. Common indications include:

Primary ankle osteoarthritis (degenerative joint disease without a clear preceding cause)
Post-traumatic arthritis following fractures or ligament injuries of the ankle
Rheumatoid arthritis with cartilage destruction of the ankle joint
Avascular necrosis of the talus (bone death due to impaired blood supply)

Ideal candidates are typically patients between 50 and 70 years of age with adequate bone stock and no severe malalignment of the foot or ankle.

Surgical Procedure

The operation is performed under general or spinal anaesthesia. The surgeon accesses the joint through an anterior (front) incision at the ankle. The damaged cartilage and bone surfaces are precisely removed and replaced by the components of the prosthesis:

Tibial component: A metal plate anchored to the tibia (shinbone)
Talar component: A metal shell placed on the talus (ankle bone)
Polyethylene insert: A plastic bearing surface between the two metal parts, allowing smooth, low-friction movement

Modern prosthetic systems are mostly implanted without bone cement and integrate directly into the bone through a specialised surface structure, a process known as osseointegration.

Advantages and Disadvantages Compared to Ankle Fusion (Arthrodesis)

An alternative to total ankle replacement is ankle arthrodesis (surgical fusion of the joint). Both procedures have specific advantages and disadvantages:

TAR: Advantage – Preservation of joint motion, more natural gait pattern
TAR: Disadvantage – Technically more demanding, higher revision rate in younger or highly active patients
Arthrodesis: Advantage – Long-term stability, well-suited for severe deformity
Arthrodesis: Disadvantage – Permanent loss of motion, increased stress on adjacent joints

Postoperative Care and Rehabilitation

Following surgery, a structured rehabilitation programme is essential for a successful outcome:

Non-weight-bearing on the operated foot using crutches for several weeks
Use of a cast or walking boot to protect the implant
Physiotherapy to restore strength, coordination, and range of motion
Manual lymphatic drainage and compression therapy to manage swelling

Full rehabilitation typically takes 6 to 12 months. Many patients are subsequently able to walk without pain and can resume low-impact activities such as swimming or cycling.

Potential Risks and Complications

As with any surgical procedure, total ankle replacement carries certain risks:

Wound healing problems (particularly relevant in patients with diabetes or vascular disease)
Implant infection
Nerve or blood vessel injury
Loosening or wear of the prosthetic components over time
Implant failure requiring revision surgery

Long-term studies report a 10-year survival rate for modern ankle prostheses of approximately 70 to 90 percent, depending on the implant design and patient selection.

References

Daniels T.R. et al. - Intermediate-term results of total ankle replacement and ankle arthrodesis: A COFAS multicenter study. Journal of Bone and Joint Surgery, 2014.
Saltzman C.L. et al. - Prospective controlled trial of STAR total ankle replacement versus ankle fusion. Foot and Ankle International, 2009.
National Institute for Health and Care Excellence (NICE) - Ankle replacement (total) for end-stage ankle arthritis. NICE Interventional Procedures Guidance, 2020.

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