Why Does My New Ankle Replacement Still Hurt After 8 Months?

Ankle replacement surgery, also known as total ankle arthroplasty, is a life-changing procedure for many people suffering from severe ankle arthritis or joint damage. It can restore mobility, reduce pain, and improve overall quality of life. However, experiencing persistent pain eight months after surgery can be frustrating, confusing, and concerning. If you’re in this situation, you’re not alone—postoperative pain is a common challenge for some patients, and it’s important to understand why it may happen, when to seek help, and how it can be addressed. So, if you have ever asked why does my new ankle replacement still hurt after 8 months, read on to find out more!

In this blog post, we’ll explore the potential reasons for ongoing pain after ankle replacement surgery, outline the steps to evaluate your situation, and provide evidence-based recommendations for addressing the issue.

What Is Normal After Ankle Replacement Surgery?

Before we dive into the reasons for persistent pain, let’s clarify what the typical recovery timeline looks like for an ankle replacement:

0-6 weeks: The first six weeks are focused on protecting the surgical site while the bone heals around the implant. Patients often experience swelling, soreness, and limited mobility.
6 weeks to 3 months: Physical therapy typically begins, gradually restoring strength, flexibility, and function. Pain should steadily decrease during this phase.
3-6 months: Most patients achieve significant improvement in function and reduction in pain, although some residual soreness may persist.
6 months to 1 year: By this stage, the majority of patients experience minimal pain and can engage in low-impact activities.

While occasional mild discomfort or stiffness may persist during the first year, ongoing pain that affects daily activities is not typical. Persistent pain after 8 months warrants a closer evaluation.

Why Might Your Ankle Replacement Still Hurt After 8 Months?

Several factors could contribute to ongoing pain following ankle replacement surgery. These causes can be categorized into surgical, biomechanical, medical, and patient-related factors.

1. Surgical Factors

Implant Alignment Issues: If the ankle implant is not perfectly aligned or positioned during surgery, it can create abnormal stresses on the joint or surrounding tissues, leading to pain and dysfunction.
Loosening of the Implant: Over time, the components of the ankle replacement may loosen, which can cause pain. Loosening is often associated with wear-and-tear, but in some cases, it may occur earlier due to inadequate bone integration or infection.
Nerve Irritation or Damage: The ankle joint is surrounded by nerves that may become irritated or damaged during surgery. Neuropathic pain, characterized by burning, tingling, or shooting sensations, could result from this.
Infection: Even months after surgery, low-grade infections around the implant can cause pain, swelling, and stiffness. This requires immediate medical attention.

2. Biomechanical Factors

Improper Weight Distribution: If the biomechanics of the ankle and foot are not properly balanced, you may develop pain in the ankle or surrounding areas like the heel, arch, or forefoot.
Overcompensation or Gait Changes: Post-surgery changes in how you walk can strain other parts of your foot, ankle, or even your knees and hips, causing secondary pain.
Tendon or Ligament Strain: The tendons and ligaments around the ankle, especially the Achilles tendon or peroneal tendons, may become inflamed or overworked if they’re compensating for changes in joint mechanics.

3. Medical Factors

Arthrofibrosis: This condition involves excessive scar tissue formation, leading to stiffness and chronic pain in the joint. It can limit your range of motion and cause discomfort even with light activities.
Osteolysis (Bone Loss): In some cases, the body’s reaction to the implant can lead to bone loss around the implant, causing instability and pain.
Complex Regional Pain Syndrome (CRPS): This rare but serious condition can develop after surgery, leading to severe, persistent pain, swelling, and sensitivity in the affected area.

4. Patient-Related Factors

Inadequate Rehabilitation: If physical therapy is not followed correctly or discontinued prematurely, muscles and soft tissues around the ankle may remain weak or stiff, contributing to pain.
Overuse or Premature Activity: Engaging in high-impact activities or failing to adhere to postoperative restrictions may delay healing or damage the implant.
Pre-existing Conditions: Conditions such as diabetes, rheumatoid arthritis, or peripheral neuropathy can delay healing and contribute to ongoing discomfort.
Compliance: One of the main reasons a patient’s ankle replacement may still hurt after 8 months, is lack of compliance. For this reason, compliance to postoperative instructions
is of paramount importance to get good clinical outcomes.

Steps to Evaluate Persistent Pain

If you’re experiencing pain 8 months after an ankle replacement, it’s important to take the following steps:

1. Consult Your Surgeon

Your surgeon is your first point of contact. They may:

Perform a physical exam to check for signs of swelling, instability, or nerve issues.
Order imaging tests (X-rays, CT scans, or MRIs) to evaluate the implant’s alignment, condition, and surrounding bone structure.
Test for infections with blood work or joint aspiration.

2. Work with a Physical Therapist

A physical therapist can assess your gait, range of motion, and muscle strength to identify any biomechanical issues that may be contributing to your pain.

3. Consider a Second Opinion

If you’re not getting answers or relief from your current care team, it may be helpful to consult another orthopedic surgeon or a specialist in foot and ankle surgery.

Treatment Options for Persistent Pain

The treatment for ongoing pain will depend on the underlying cause. Here are some possible solutions:

1. Non-Surgical Treatments

Physical Therapy: Strengthening and stretching exercises can address muscle imbalances, stiffness, or biomechanical issues.
Orthotics or Bracing: Custom orthotics or an ankle brace can help redistribute pressure and improve alignment.
Medications: Anti-inflammatory medications, nerve pain medications, or injections (such as corticosteroids) may provide temporary relief.
Lifestyle Modifications: Avoiding high-impact activities and maintaining a healthy weight can reduce stress on the joint.

2. Surgical Treatments

Revision Surgery: If there’s an issue with the implant (e.g., loosening, misalignment, or infection), a revision surgery may be necessary to correct the problem.
Arthroscopic Procedures: For cases involving scar tissue or soft tissue impingement, minimally invasive arthroscopy may help alleviate pain.

When to Seek Immediate Medical Attention

While persistent pain is frustrating, there are certain “red flags” that require urgent attention:

Sudden, severe pain in the ankle.
Signs of infection, such as fever, redness, warmth, or drainage from the surgical site.
Inability to bear weight on the affected leg.
Rapid swelling or deformity of the ankle.

If you experience any of these symptoms, contact your surgeon immediately or go to the nearest emergency room.

Conclusion

Persistent pain eight months after an ankle replacement can occur for a variety of reasons, ranging from minor biomechanical issues to more serious complications like implant loosening or infection. The key to addressing this problem is identifying the underlying cause through thorough evaluation and seeking timely treatment. By working closely with your healthcare team and following their recommendations, most patients can resolve their pain and return to a more active and pain-free life.

If you’re struggling with ongoing ankle pain, don’t hesitate to speak up—it’s your right as a patient to feel comfortable, confident, and informed about your recovery journey.

FAQs

How long does pain last after total ankle replacement?

Pain typically decreases significantly within the first 3-6 months after total ankle replacement. Mild discomfort, swelling, or stiffness may persist for up to a year as the joint continues to heal and adapt. However, severe or worsening pain beyond this timeframe may indicate a complication and should be evaluated by your surgeon.

How long should my ankle hurt after surgery?

Mild to moderate pain is normal for the first 6-12 weeks as tissues heal. By 3-6 months, most patients experience substantial pain relief. Persistent pain beyond 6 months is less common and may require further investigation to rule out complications such as implant issues, infection, or biomechanical problems.

How do you know if something is wrong after ankle surgery?

Warning signs of complications include:

Persistent or worsening pain after 6 months.
Redness, warmth, swelling, or drainage (possible infection).
Instability or clicking in the joint.
Inability to bear weight.
Numbness, tingling, or sharp nerve pain.
If you notice any of these symptoms, contact your surgeon immediately.

Can an ankle replacement be done twice?

Yes, revision ankle replacement surgery can be performed if the initial implant fails due to loosening, wear-and-tear, infection, or misalignment. However, revision surgeries are more complex and require specialized expertise. The longevity of the second replacement may also be shorter than the original.

What bones are replaced in an ankle replacement?

In total ankle replacement, the damaged surfaces of three bones are replaced:

The tibia (shinbone) where it meets the ankle joint.
The talus (bone between the tibia and heel).
In some cases, part of the fibula (outer lower leg bone) may also be involved.
The natural joint surfaces are replaced with metal and plastic components.

Can plates and screws cause pain years later?

Yes, plates and screws can cause pain years later if they irritate surrounding tissues, nerves, or if bone overgrowth occurs. Additionally, hardware complications such as loosening, fracture, or inflammation can contribute to discomfort. If pain persists, surgical removal of the hardware may be necessary.

What is the best age for ankle replacement?

Ankle replacement is generally recommended for patients between 50 and 70 years old, as they are less likely to place excessive stress on the implant compared to younger individuals. However, suitability depends on factors such as activity level, overall health, and the severity of joint damage, rather than age alone.

Thats it on why does my new ankle replacement still hurt after 8 months. All the best! You may also find the complete guide to ankle surgery helpful.

Reference

Gershkovich, G., Arango, D., and Ndu, A. (2016) ‘Weight Bearing Compliance after Foot and Ankle Surgery’, All Articles. Available at: https://doi.org/10.1177/2473011416S00089