Ankle arthritis is a debilitating condition, that effects many people in our community. Arthritis is a process where cartilage is damaged resulting in “bone on bone” rubbing in the joint. Patients with ankle arthritis have severe pain and decreased motion of the ankle that limits their ability to participate in their work and recreational activities. At the ROC Center for Foot and Ankle, we offer many non-surgical options such as bracing, physical therapy, and injections. When these options don’t work for our patients, we offer successful surgical options.
Unlike knee and hip arthritis, ankle arthritis is oftentimes related to an injury of the ankle which is typically from multiple sprains or a fracture. Patients with ankle arthritis tend to be younger than those patients with hip and knee arthritis. Treatment options may be difficult in this population because they are often high demand patients.
What procedures can be done to save the ankle joint?
Sometimes procedures can be done that save the ankle joint. The procedures may be relatively simple such as arthroscopy, where the surgeon performs the surgery using two relatively small holes to access the ankle joint with a camera and different tools to “clean up” the joint of scar tissue and cartilage damage. Oftentimes, bone spurs are removed at the same surgery.
Other procedures performed by ROC surgeons include osteotomies, which includes cutting bones to realign the joints to take the pressure off the arthritic portion of the joint. Finally, in special circumstances, we will utilize a special external fixator, called an illizarov frame, to distract the joint to allow a cartilage scar called fibrocartilage to form. This is a long process generally requiring approximately three month commitment by the patients to live in the external fixator. Results of this procedure can be successful in the right patient.
What procedures are available if saving the ankle joint is not possible?
Fusion of the ankle has been the treatment of choice for patients with ankle arthritis for many years. A fusion is a procedure that causes bone to grow across the joint. Although a fusion works well for pain relief, patients lose motion across their joint and may develop arthritis in other joints of the foot.
Fortunately, a Total Ankle Replacement (TAR) may be available for the right patient. This procedure has been available for over 30 years in Europe, however, has been much improved over the past 10 years in the United States. TAR is very similar to the well known total knee and total hip replacements. The surgeon replaces each side of the joint with a metal piece and then places a plastic bearing between them for smooth motion. Like a knee and hip replacement, patients with TAR have very good relief of their debilitating pain while maintaining their ankle motion. Recent studies have shown patient outcomes following TAR to be superior to ankle fusion. Long tern success is also excellent with over 70% of patients still have their original replacement after 14 years.
Another benefit of TAR is the relatively easier recovery over fusion. Fusion requires long periods of casting and limited weight bearing. With a TAR, we allow weight bearing after two weeks and begin physical therapy to maximize motion and limit muscle weakness. Recovery and pain relief occurs quickly and by three months, most patients are back to walking and low impact activities such as golf. In the long run, we anticipate the majority of patients to be able to go for walks, hikes, cycling, tennis, skiing, golf and other activities that don’t put a lot of stress across their ankles.
At the ROC Center for Foot and Ankle, we are dedicated to improving the lives of patients with ankle arthritis. Our team has performed approximately 200 TAR with good success, the most in Northern Nevada and the greater Sierras. We are also committed to the success and improvement of TAR. We teach other surgeons from across the country TAR techniques of this procedure. In addition, our surgeons have published many research studies in international medical journals and presenting and speaking at national meetings. Please see the below links for a few of our publications.