Since 1969 at the ankle joint prostheses are used. Numerous difficulties have ankle prosthetics long time not to be, which hip and knee prostheses in orthopedics show.
The fusion (arthrodesis) at the upper ankle joint is now increasingly seen as a last retreat used for many years because it is known that after stiffening of joints with a big game consequential movement there. The neighboring joints develop regularly called Begleitarthrosen. The prosthesis design and the method of anchoring ankle prosthesis were changed and thus the result of improved therapy. 
How is an ankle joint prosthesis of the new generation constructed?
The modern ankle prosthesis, the anchor leg with a metal cap over the tibia and articular surface with a metal plate. The third component of the prosthesis is a freely movable polyethylene Gleitkern the important movement between the two joint partners. The free movement of Gleitkernes allows for a stress-free strain of the bone surface. The prosthetic parts are modeled after the anatomy and cement are now freely used.
Important for a good shelf life is usually after an accident resulting deformities and tape to fix damage.
Fitting a prosthesis at the ankle joint is in general anesthesia or regional anesthesia. The storage is done on the back. We use depending on the planned length of the operative interference targets a cuff on the thigh to hold back the blood (blood barrier), or operate most of the time without such a sleeve. |  |
| How is the ankle joint be replaced? |
- Applying an adhesive film on the skin
- Wearing a special helmet system sterile
- Antibiotikumgabe front investment of blood blocking cuff
- Operation in a cleanroom operation
- Gentle soft tissue treatment on ankle
- Avoiding wound during the operation
Fitting a prosthesis at the ankle joint is in general anesthesia or regional anesthesia. The storage is done on the back. We use depending on the planned length of the operative interference targets a cuff on the thigh to hold back the blood (blood barrier), or operate most of the time without such a sleeve.
The skin in the surgical field is disinfected with alcoholic solutions, then covered with sterile towels.
Additional precautionary measures for infection are:
- Applying an adhesive film on the skin
- Wearing a special helmet system sterile
- Antibiotikumgabe front investment of blood blocking cuff
- Operation in a cleanroom operation
- Gentle soft tissue treatment on ankle
- Avoiding wound during the operation
In addition, a sterile covered X-ray image converter (moving X-ray equipment with immediate Bildbetrachtung) prepared for the situation, the size of Sägeschnitten to be able to navigate and position of the ankle joint prosthesis to be able to control.
The incision is on the front of the ankle. He usually goes hand-width above the shin down on the instep.
The front of the ankle ligaments is to be kept aside and the anterior joint capsule shows leap. Partial cutaneous nerves must be in operation will be relocated. The joint capsule is opened and the installation of the ankle prosthesis prepared. This must be a lot of extensions bone removed to maintain a good overview of the joint can be achieved.
With the help of objective instruments and prepared the following image converter, the axis of the leg and the planned location of the ankle prosthesis controlled. There are some Sägeschnitte to the placement of the ankle joint replacement is necessary. The aim of sparing bone removal is the soft tissue tension of the ankle again.
The mobility, stability and strength of the ankle joint with a prosthesis can sample prostheses reviewed.
Have these been achieved will perfectly position the rear foot controls and controls on the length of the Achilles tendon. Are these sufficient for a good function of the ankle can continue supporting interventions will be necessary.
The original parts of the ankle prosthesis is then implanted cement-free.
The anchor leg with a metal cap over the lower surface of the metal pins to have leadership. The tibia articular surface with a metal plate. Both parts of the ankle joint replacement can be found on the side adjacent to the bone with a special coating to ensure a secure ingrowth of bone to reach.
The third component of the modern ankle prosthesis is a freely movable Kunststoffgleitkern from polyethylene, the key movement between the two joint partners. 
Who benefits from an ankle prosthesis?
From an ankle joint replacement with a modern ankle prosthesis particularly benefit patients with a joint wear and tear (osteoarthritis) of the upper ankle with pain, movement restrictions and conservative therapy attempt.
The shape of the ankle arthrosis is not crucial for the security of a prosthesis at the ankle. Both arthritis of unknown cause, Sprunggelenksarthrosen after an accident, injury, rheumatic disease and Knochentod leg of the jump can be supplied.
Favorable conditions for an artificial replacement of the ankle
- Mean activity level and not too high demands on the motion ankle
- good bone substance of the ankle
- good vascular status of the leg
- still well-preserved joint mobility of the ankle and lower ankle
- good management of the ankle band
Unfavorable for the supply of an ankle prosthesis are:
- High body weight in osteoarthritis of the ankle
- High physical activity
- Past infection of the ankle joint
- Osteoporosis
- Diabetes mellitus
- High nicotine
- Divergent stress axes, more flexibility in the upper and lower ankle joint (misalignments and instabilities)
What monitoring procedures may be obtained from the ankle prosthesis necessary?
For a good durability of the prosthesis at the ankle, it is crucial-malpositions and tape damage to fix. The main goal is a vertical load of the implants while standing reach, because only then the high weight load on the ankle prosthesis evenly distributed. To see all possible malpositions to recognize a series of X-rays under stress may be made and analyzed in detail, the strength and mobility of the ankle can be achieved by examination of the specialist physician assessed.
The following interventions may be necessary accompaniment:
- Position correction by an operation on the lower leg at the heel and midfoot.
- Soft tissue interference with solution or shortening of tendon
- Volume sculptures on the inner or outer band of the ankle
Monitoring interventions such as switching operations can be done already as a first step therapy months before the artificial joint are carried out. We partially corrected in the run-up to the ankle prosthesis can still be delayed. In recent years it has become more and more shown that a proper load on the injured ankle, even without the replacement of an ankle replacement can be helpful. Moreover, the surgical risks by lowering intervention significantly reduced length.
How long are you looking for a prosthetic ankle surgery stationary? 
The duration of lying in the hospital is approximately 5-7 days. The early phase of securing the early healing phase and the specific pain. Lymphdrainge, high storage and pain are important components of inpatient therapy.
How is the post-treatment at the ankle replacement without accompanying bony encroachment?
The prosthesis of the ankle bone ingrowth in need, this is a too heavy burden obstructive and too little stress little help.
Until the wound after 14 days is a conservative mobilization in a special shoe (ROM Walker) with a low burden of Unterarmgehstützen recommended. After that, under fully loaded but physical and general conservation umhergegangen be. The special shoe serves to protect against Umkicken in the first phase of habituation to their new ankle prosthesis.
After 6-8 weeks, a new X-ray inspection is carried out and further stress on the structure and shoe care spoken:
Physiotherapy and lymphatic drainage are important components of treatment. Initially, the lymphatic drainage is more important than the exercise therapy.
Regular terrycloth after an ankle replacement is recommended, since the wound even after careful and sparing surgery only partially delayed.
When you can after the ankle replacement drive?
Generally, participation in the road only if the affected leg in any dangerous situation is when fully loaded. Normally this is only after 8 weeks of the event.
If after the stay at an ankle joint prosthesis rehabilitation necessary?
After ankle replacement are usually about a week in hospital. A direct transfer to a rehabilitation clinic after the ankle prosthesis made. Since that date no proper rehabilitation treatment is possible, we recommend a delay in outpatient or inpatient rehabilitation.
What can I expect from an ankle prosthesis expect?
The ultimate goal of operating with a supply ankle replacement:
- Improving the quality of life.
- Improvement in the ankle joint pain
- Normalization of gait after joint replacement
- Improvement of mobility after ankle prosthesis
- Agility in the ankle is only partially improved
- 9 $ 0% initially satisfied patients after ankle replacement
What is at risk of a prosthetic ankle operation?
Long-term results of ankle replacement are the subject of ongoing scientific investigations. The 8 year survival rate is approximately 90%. The postoperative rate depending on the group around 6-8%.
What are the alternatives for treatment of ankle prostheses are known?
The stiffening of the upper ankle was and still is for many orthopedic surgeons as the so-called gold standard. The stiffening of the ankle arthrodesis or the stability data are better known than the prosthesis.
The literature data but also on problems of arthrodesis:
- After treatment duration up to the joint Durchbauung about 4 months
- Missing Durchbauung arthrodesis on the ankle (Pseudarthrose)
- Emergence of Begleitarthrosen in neighboring joints is described.
What complications can arise a Sprunggelenksendoprothese (OSG TEP) directly after the operation type?
- Problems with wound healing above the ankle prosthesis
- Swelling of the lower
- Infection or suppuration of the ankle prosthesis
- Blood clots, or thrombosis of the deep leg veins
- Fracture of the ankle Fork of the ankle
What complications can further later after installing a Sprunggelenksendoprothese (artificial ankle) arise?
- Einsteifung of the ankle or the mobility of the ankle is lost
- The ankle joint prosthesis loosening without infection
- The ankle joint prosthesis decreases in deeper into the bone.
- Abrasion or wear of the ankle joint prosthesis.
