Should I consider an ankle replacement for for my ankle arthritis?
What is ankle arthritis?
Ankle arthritis is a condition that there is diffuse and irreversible damage to the cartilage and bone of the ankle joint. They most commonly occur after traumatic events and are less commonly related to inflammatory conditions and idiopathic causes. Patients usually suffer from pain, stiffness, swelling, and deformity making it difficult to perform daily activities.
What are the non-surgical treatments available for ankle arthritis?
Ankle arthritis can be treated with several nonsurgical methods including activity modifications, anti-inflammatory medications, bracing, cortisone injection, and viscosupplementation. Patients with underlying inflammatory diseases may benefit more from anti-inflammatory medication and cortisone injections. Bracing such as an ankle-foot orthosis (AFO) can be helpful as a long-term treatment by avoiding overloading to the ankle from external protection. Viscosupplementation with hyaluronic acid is an emerging treatment with good safety and efficacy but requires more studies.
What are the surgical options for ankle arthritis?
Surgical treatments of ankle arthritis include arthroscopic debridement, realignment osteotomies, ankle distraction, ankle fusion, and ankle replacement. Arthroscopic debridement is appropriate in early disease where most symptoms are located in the bone spurs and inflamed synovium at the periphery of the ankle joint. Realignment osteotomies are considered when a malalignment is the major cause of localized arthritis such as severe varus or valgus deformities. Ankle distraction has moderate success in preserving the ankle joint in young patients. Ankle fusion and ankle replacements are the two most successful options in patients with painful end-staged ankle arthritis. Dr. P generally prefers the use of arthroscopy to assist in ankle fusion using a minimally invasive technique.
Am I a candidate for an ankle replacement?
Ankle replacement is appropriate when conditions from the patients and surgeons are fulfilled. Ideal patients who will benefit from an ankle replacement are those
1. 60 years or older
2. Requiring low-impact activities
3. Absence of poorly controlled diabetes, neuropathy, morbid obesity, and avascular necrosis
What are the risks and benefits of ankle replacement?
Risks: wound infection, prosthetic joint infection, aseptic loosening, nerve damage, stiffness, nonunion, hardware related symptoms, blood clots
Benefit: pain relief, preserved ankle motion, improved walking gait, avoidance of long-term bracing
What is the recovery after an ankle replacement?
Dr. P’s postoperative protocols include a non-weight-bearing of 6 weeks using crutches, or a walker, and/or a knee scooter. Patients will keep the postoperative splint clean, dry, and intact until the first follow-up at 2 weeks after surgery. Afterward, a boot or a cast will be put on in the clinics. At the 6-week point, postoperative X-rays will be obtained to assess bone healing prior to the start of progressive weight-bearing. Patients can usually return to normal shoes and light daily activities without a walking aid by 12 weeks after surgery. Driving can normally resume when the patient stops taking pain medication and can walk comfortably typically around week 8; a trial of driving under family-member supervision is recommended.
Author: Phinit Phisitkul, MD
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