Total Ankle Replacement/Ankle Fusion

Osteoarthritis is a condition that causes pain, stiffness and swelling in joints. It occurs more frequently in older individuals. Primary ankle arthritis, “wear and tear” arthritis, is rarely found in the ankle. More common is post-traumatic arthritis, which can be caused by a previous ankle fracture, a series of recurrent ankle injuries or even an alignment deformity which causes uneven loading of the ankle joint. These injuries all result in cartilage loss to the bones that comprise the ankle joint leading to pain and stiffness. Rheumatoid arthritis which is an autoimmune condition caused by an inflammation in the lining of the joints can also cause ankle arthritis. In addition to osteoarthritis and rheumatoid arthritis, there are other types of arthritis, and depending on the cause, may affect people of different ages. A gout is a form of arthritis caused by a build-up of uric acid within the body, that causes painful, swollen, red and inflamed joints.

Patients with severe or end-stage ankle arthritis usually present with decreased range of motion to the joint accompanied by pain and swelling. Patients will usually complain of pain as they begin the activity and it may take a few minutes to “warm-up” the ankle.  Bone spurs usually develop around the ankle as arthritis progresses.

Diagnosis of Ankle Arthritis

Ankle arthritis is diagnosed through physical examination and imaging exams.  Weightbearing x-rays are obtained and will usually show a loss of joint space to the ankle. Bone spurs and bone whitening near the joint is usually visible on x-ray examinations. CT scans and MRI’s are also utilized in the evaluation of arthritis.

Treatment

Conservative (Non-Operative) Treatment

Ankle arthritis is one of the most common conditions we treat in the office.  Treatment for ankle arthritis varies based on type and symptoms. Conservative treatment may include oral medications, joint injections, and lifestyle modifications.  Shoes with a stiff sole and a rocker bottom contour can be used to decrease the load through the ankle during ambulation, resulting in decreased pain. When conservative treatment fails, surgical intervention is often necessary.

Surgical Treatment

Ankle arthroscopy is a minimally invasive procedure used to treat mild forms of arthritis.  A tiny camera that transmits images onto a computer screen is utilized to guide small instruments to remove bone spurs and inflamed tissue within the ankle joint.

The most common treatment for severe ankle arthritis is an ankle fusion, in which the bones are fused together with screws. This method is very successful in relieving ankle pain.  Due to the motion of your hindfoot joints, patients will still be able to move their foot up and down in an arc of approximately 20-30 degrees. 

However, total ankle replacement is becoming more popular for the treatment of ankle arthritis. It is a surgical procedure used to relieve pain and restore movement to the damaged ankle joint.  It involves removing the damaged joint and replacing it with an artificial joint. While it is difficult to restore full function to the ankle, many patients are able to experience a drastic improvement in ankle function after this procedure.

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