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Surgery & Special Procedures
Ankle Arthritis: When Is It Time for Surgery?

HealthReach, Fall 2012 | Page 7

Most people are familiar with the crippling pain of hip or knee arthritis and know that a hip or knee replacement can dramatically improve their quality of life. Ankle arthritis can be just as debilitating, yet many people simply suffer with the pain— even though treatment can be very successful. Steven Neufeld, MD, and Matthew Buchanan, MD, orthopedic surgeons specializing in foot and ankle surgery, explain what causes ankle arthritis and the available treatment options.

What causes ankle arthritis?

When the cartilage between the bones in our joints is damaged or gone, the underlying bone is exposed. When the joint moves and the two bones move on each other, it causes pain. The body’s response is inflammation, pain, swelling and bone spurs that form over a long period of time.

What are the symptoms?

Symptoms include swelling, pain with standing and walking, pain that tends to get worse with activity, and the ankle giving way.

Who is at risk?

More than 70 percent of patients with ankle arthritis have had a previous injury, such as an ankle break or fracture, or a bad sprain that damaged ligaments and cartilage. Those types of injuries are very common as a lot of us are trying to stay active through jogging, playing tennis or basketball, or other sports. A lot of young soldiers also are spraining or breaking their ankles.

When is it time to see your doctor?

Ankle arthritis is a progressive problem that will not heal without treatment. The reduction in quality of life can be truly severe. If you start to notice that your ankle is bothering you, make an appointment. If we catch it early, there are a lot of non-surgical options. How is ankle arthritis diagnosed? We perform a physical exam and take an X-ray.

What are the non-surgical treatments?

We start with over-the-counter pain medications and braces that limit motion in the ankle. Physical therapy can strengthen ankle tendons and ligaments. If you’ve had a previous fracture, shoe orthotics can correct underlying alignment problems. If those treatments are not successful, we can treat ankle arthritis with injections. Traditionally, we have used cortisone injections, but some newer techniques are proving to be effective. Injecting platelets or bone marrow from the hip into the ankle may stimulate regeneration of cartilage.

What are the surgical options?

Ankle fushion or total ankle replacement surgery is considered when the arthritis is severe. In ankle fusion, we glue the joint together so that it doesn’t move up and down. That relieves the pain because the bones aren’t rubbing against each other, but it can cause alterations in gait. As a result, arthritis tends to develop in other joints in the foot over time, which may necessitate additional procedures.

With total ankle replacement, the damaged joint is removed and replaced with an artificial ankle that preserves more natural joint movement. New advances in engineering and materials have led to greater ankle support and longer-term joint stability than earlier implants. There is a 90 percent success rate at 10 years.

How does total ankle replacement compare to ankle fusion?

The pain relief with both procedures is very good, but the functioning and range of motion in the joint is much better with total ankle replacement. Ankle replacement is not an option, though, if there is an active infection, if the skin is damaged around the ankle, or if a bone is missing due to previous trauma. For those patients, ankle fusion is recommended.

What can patients expect with total ankle replacement surgery?

The hospital stay is usually one to two nights. Initially, patients are on crutches or use a scooter or a wheelchair for about four weeks. At six weeks, they can start to get back into a normal shoe. Once they’re walking, patients will do physical therapy twice a week for four to six weeks to maximize their range of motion. After total ankle replacement, these are some of our happiest patients. It’s a life-changing surgery. Some patients wake up from surgery and say, “My pain already feels so much better.”

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