Severe ankle joint arthritis is the result of progressive wear and tear of the articular cartilage cushion that lines the ankle joint, which results in bone-on-bone grinding of the joint surface.
Commonly referred to as “end stage” arthritis one experiences pain, and loss of function and mobility – limiting normal activity. When the end stage is reached and non-operative options (including medication, injections, and use of a brace) have been exhausted, patients are presented with three methods of surgical treatment: ankle fusion, total ankle replacement (TAR) and, in some cases, distraction arthroplasty.
Treatment options for end-stage arthritis of the ankle
Traditionally, when confronted with end-stage arthritis, some patients undergo a fusion, or arthrodesis, a procedure that creates raw bone surfaces that are held together with metal plates and/or screws until the bone surfaces unite or fuse. The goal of fusion is to fix the joint in the correct position; pain is relieved at the expense of loss of motion at the ankle joint. The ankle is generally out of action for approximately 10-12 weeks (until the fusion is solid).
This procedure is helpful for patients as a means of pain relief. However, there are concerns regarding arthrodesis procedures. Because an ankle fusion results in loss of motion, the joints surrounding the ankle flex and extend to compensate. While this allows most fusion patients to walk without a limp, the primary concern is that these adjacent joints run the risk of becoming arthritic themselves.
An alternative is a total ankle replacement forgoing the fusion process, this procedure instead relies on the replacement of the arthritic surfaces with an implant that is composed of two or three components that glide against each other using low-friction materials. The primary benefit is pain relief with retained ankle motion.
The TAR procedure requires a shorter immobilization period and has been shown to provide a functional range of motion in the ankle, allowing patients to actively engage in daily tasks (and low-impact sports). More importantly, TAR results in a smaller amount of stress upon the surrounding joints, reducing the risk of arthritis in those areas as well.
A third option for some patients with end-stage arthritis is a procedure called distraction arthroplasty, a surgical process aimed at younger patients that involves placing the ankle in a framework of pins set into the bones and then slowly adjusting that framework in order to distract (pull apart) the joint surfaces. In theory, this aids the body in regenerating ankle cartilage.
Patients must have proper alignment of the foot for the procedure to be successful. The fixator holding the pins around the ankle is generally in place for ten weeks. Studies show that this procedure has a 60% rate of success.
What Is The Proper Treatment
Regardless of the condition of the ankle, treatment is determined on a case-by-case basis. Factors in determining the proper treatment include age (generally, candidates for TAR are aged 50 or older), activity level, body weight, quality of bone stock, overall alignment of the foot, stability, and degree of arthritic severity.
Generally, candidates for total ankle replacement have good mobility, with good bone stock and foot alignment. TAR should only be performed by an Orthopedic Surgeon who is well-versed in the procedure who can determine the best type of implant for the patient.
Implants for Total Ankle Replacement
The difficulties in creating an effective implant for total ankle replacement can be largely attributed to the complex motion at the ankle joint. The center of rotation, or axis, of the ankle joint does not remain constant through the course of motion. The “trick” is to allow for rotational forces while moving through a range of flexion and extension.
Conclusion
When ankle arthritis has progressed to an advanced stage, where non-surgical methods of treatment are no longer effective, several options are available. When determining the best possible treatment for each patient, numerous factors will be considered by an orthopedic surgeon specializing in foot and ankle surgery, including age, activity level, body weight, bone quality, alignment, and severity of arthritis. It is important to consult a foot and ankle specialist who understands the factors that influence the condition of the ankle, and who is able to recommend the best option for relief of arthritic ankle pain.
Dr. Bagwe is a leading orthopedic surgeon specializing in ankle and foot reconstruction. If you are looking for an orthopedic surgeon near you then look no further. Dr. Bagwe is an industry leader when it comes to foot and ankle surgery doctors in St. Louis. Dr. Bagwe and his friendly and professional team is ready to welcome you and tell you everything you need to know.
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