Ankle Arthritis Treatment
Our surgical treatment of ankle arthritis is divided into four main categories:
- Arthroscopic removal of the spurs, in other words, a “clean out” of the arthritis in your ankle.
- Ankle fusion, which is the most common treatment for ankle arthritis.
- Ankle replacement, which is a new and exciting treatment for ankle arthritis.
- Distraction arthroplasty, which is a somewhat experimental treatment to try to preserve your ankle joint.
Arthroscopic treatment of ankle arthritis involves putting a small camera in your ankle joint through a mini-incision and removing the spurs. This treatment usually works for very mild ankle arthritis that is limited to one part of your ankle in patients who have a spur. This commonly occurs after a sprain or spurs develop in the front of the ankle and patients lose motion but they can function quite well otherwise. This is almost always done to try to return the patient to sports activity and rarely is done for advanced ankle arthritis.
An ankle fusion is a common procedure performed for ankle arthritis in which the tibia and talus bones are fused together with screws. The foot is still able to move up and down following an ankle fusion because the hindfoot joints contribute some to the up and down motion of your ankle. The surgical procedure is usually performed under an epidural anesthetic with a popliteal block (do not worry, you are asleep for all of it but breathing on your own). We remove the diseased cartilage inside your ankle joint, and usually place bone graft either from synthetic bone graft or bone graft from below your knee in the space. The bone graft functions as a type of grout material to make the fusion heal faster. This procedure usually requires an in-patient hospitalization of 1 to 2 days and a postop of 1 or 2 days. The postop course usually involves the patient wearing a cast and not bearing weight on the ankle for 4 to 6 weeks’ time. They need to be on crutches or a walker during this time. Usually, at the six-week mark, we take an x-ray. If the ankle fusion looks good, then we transfer you to a removable boot, which then lets you start putting weight on it. By 10 weeks, most patients are able to walk just in the boot and start to transition to a shoe sometime around the third month. However, it is noted that it takes probably 6 to 9 months to completely recover from an ankle fusion. An ankle fusion is a very successful operation in terms of pain relief. While the ankle is stiffer than it was before, you are still able to walk normally in a shoe and still participate in most of your activities, except running.
Ankle replacement is a very exciting technique for ankle arthritis. I started performing ankle replacements in 1998 and have performed over a 120 ankle replacements since then. The ankle joint is a difficult one to replace because of the tremendous forces across the ankle joint. The forces across the ankle are 4-5 times higher than across the hip or the knee and over a much smaller surface area, making wearing out of the joint much more frequent than in hip or knee replacements. We have come a long way in the treatment of ankle replacement and now have four or five different prostheses to offer patients. This is a very exciting time for us and for patients who have ankle arthritis. With the correct candidate, ankle replacement is no longer an experimental option for patients, but a viable surgery option for the treatment of ankle arthritis.
The design of the ankle prosthesis has taken a long time to perfect. We originally performed the Agility prosthesis with good success between 1998 and 2006 (see reference on agility Kopp et al). This was the only full ankle replacement on the market during those years. However, starting in 2006, the FDA approved three more ankle replacements, and now I perform the Salto Talaris replacement (Tornier), as well as the INBONE replacement from Wright Medical.
The Salto Talaris replacement is an excellent choice for patients with little deformity around their ankle joint. It has minimal bony cuts and resurfaces both the tibia and talar surfaces. Its instrumentation allows the two components to find the sweet spot in ankle motion to allow for greater flexibility. We have been very happy to date with our results with the Salto Talaris replacement. Click here to learn more about Salto Talaris Ankle Replacements
The INBONE replacement from Wright Medical is the most radical design of all the ankle replacements. It is an intermedullary design, which allows for greater fixation of the components in both the tibia and talus. It does require a little bit more bone resection to put in. It also requires a longer operative procedure. It has an incredibly intricate guidance system that allows us to place the implant exactly at the precise spot we want. We have been very happy with the INBONE replacement for those patients with severe arthritis, for those patients who have had a revision ankle replacement, and those patients who have a lot of deformity around the foot and ankle. Click here to learn more about Ankle Arthritis