Ankle arthritis is a degenerative condition that can cause significant pain and functional limitation. Although it is less common than other forms of arthritis, we do know that ankle arthritis has an impact on patients’ lives that is similar to that experienced by patients with end-stage knee and hip arthritis.
If arthritis doesn't respond to nonsurgical treatment, surgical treatment might be considered. The choice of surgery will depend on the type of arthritis, the impact of the disease on the joints, and the location of the arthritis. Surgery performed for arthritis of the ankle includes arthroscopic treatment, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).
Traditional nonsurgical treatment options for symptomatic ankle arthritis include activity modification, anti-inflammatory medications, bracing, and assistive devices. A wide range of additional treatments including physical therapy modalities can also be used.
Arthroscopic surgery may be helpful in the early stages of arthritis. A flexible fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin. The arthroscope is fitted with a small camera and lighting system, as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the problem areas.
Small instruments at the end of the arthroscope, such as probes and shavers, are used to clean the joint of inflamed tissue that lines the joint and bony outgrowths (spurs). Isolated areas of cartilage loss can be treated with techniques that include microfracture, cartilage transplantation as well as the use of new biologic alternatives to stimulate the body to reproduce cartilage in the defect.
Arthrodesis fuses the bones of the joint completely, making one continuous bone. The surgeon uses plates and screws, or rods to hold the bones in the proper position while the joint fuses. Ankle fusion can provide a reliable method of pain relief for severe ankle arthritis. One long-term problem with fusion is the development of arthritis at the joints adjacent to those fused. This occurs from increased stresses applied to the adjacent joints.
In arthroplasty, the damaged ankle joint is replaced with an artificial implant. Although early implant designs for TAA resulted in high failure rates, newer designs have demonstrated promising short- and medium-term results. In addition to providing pain relief from arthritis, ankle replacements offer patients better mobility and movement compared to fusion. By allowing motion at the formerly arthritic joint, less stress is transferred to the adjacent joints. Less stress results in reduced occurence of adjacent joint arthritis.
Ankle replacement is most often recommended for patients with:
- Advanced arthritis of the ankle
- Destroyed ankle joint surfaces
- An ankle condition that interferes with daily activities
As in any joint replacement surgery, the ankle implant may loosen over the years and revision surgery may be necessary.
1) American Academy of Orthopaedic Surgeons (AAOS) – OrthoInfo
2) American Orthopaedic Foot and Ankle Society (AOFAS) – FootcareMD
Dr. Naven Duggal is a board certified orthopaedic surgeon and member of the AAOS and AOFAS. He treats all types of adult & adolescent foot/ankle problems including bunions, hammer toes, flat foot deformities, sports injuries, arthritis and fractures.