Ankle Arthritis

  • Ankle arthritis

    Arthritis is the end result of damage to the joint. It can be due to degeneration (ageing) or repeated injury to the joint due to sport or due to lack of sensation in the joint as in advanced diabetes (called as Charcot's joint). The resulting joint is painful, and is unstable when walking.

    Your podiatric surgeon will give the best options.

    Management

    Non-operative treatment can be useful in the early stages of ankle arthritis. Physiotherapy helps by strengthening the muscles around the ankle. Injections of steroid and local anaesthetic into the joint can help for shorter periods of time but need to be repeated. Orthotics like a brace, shoe or boot with a stiffened sole with a gentle curve from heel to toe, a rocker sole, are very useful in treating ankle arthritis.

    Rest

    Rest is usually with a brace. Bracing reduces movements and gives pain relief.

    Ankle brace
    Ankle brace
    Ankle joint injection
    Ankle joint injection

    Classical treatment in the past was an ankle fusion in which the ankle is fused with screws, nail or locking plates. Screws can be inserted arthroscopically with quick recovery and early mobilization. End result of the procedure is usually good with a stiff, but stable and painless joint.

    Ankle arthritis
    Ankle arthritis
    Ankle fusion using screws
    Ankle fusion using screws

    If there is extensive arthritis of joints across the ankle like the sub-talar joint, then a triple fusion or a pan-talar fusion is a better option than an ankle replacement surgery or ankle fusion.

    Pan-talar fusion with screws
    Pan-talar fusion with screws
    Pan-talar fusion with a nail with additional option of Triple fusion.
    Pan-talar fusion with a nail with additional option of triple fusion


    Ankle replacement surgery

    Unlike the past, where ankle arthritis was treated with fusion of the joint, which results in a stiff and non-mobile joint, ankle replacement has come of age.

    The turnaround is predominantly due to better understanding of the biomechanics of the ankle joint and strides in metallurgy of the implant.

    The joint replacement has got 3 components.

    • Tibial tray
    • Talar component
    • UHMWPE (Ultra high molecular weight polyethylene)

    The diseased joint is removed, and replaced with metal alloy, cemented on either side to the bone and a UHMWPE plastic insert is sandwiched in between.

    Ankle replacement Surgery
    Ankle prosthesis
    Ankle replacement Surgery
    Xray showing ankle replacement surgery

    Standard post-operative regimen

    • Post-op continuous passive mobilization (CPM)
    • Immediate weight bearing and walking with frame and stick
    • Physiotherapy is mandatory for six weeks.

    Longevity and other options

    Ankle replacement with the STAR system averages 85% at the 8 yr mark and probably 75% at 15 yr mark.

     Both these deformed ankles are best treated by ankle fusion or pan-talar fusion

    Both these deformed ankles are best treated by ankle fusion or pan-talar fusion

    Ankle fusion is a very good option for end-stage arthritis of the ankle. There are certain limitations for ankle replacement surgary. Longevity is not as high as compared with say, a total knee replacement. Then very deformed inward ankle (varus) and deformed outward ankle (valgus) should not be treated with a replacement surgery. Although movements at the ankle are lost, ankle fusion is the 'gold standard' for pain relief.