Ankle Arthritis

What is ankle arthritis?

Arthritis is basically inflammation of a joint. Joints allow motion in our body between two bones. When a joint becomes inflamed, it may become swollen, painful or stiff.

What causes ankle arthritis?

There are many causes for ankle arthritis. While each process happens differently, the end result is still damage to the joint with inflammation leading to pain.

One of the main causes of ankle arthritis is prior injury or trauma to the joint. This may lead to direct damage to the cartilage. Prior injury may also leave a patient with an alignment abnormality or instability. These conditions can cause damage to cartilage and the joint over time and lead to arthritis.

Osteoarthritis (normal wear and tear associated with aging) is a process where the cartilage, or joint surface, wears out with aging in some patients leaving an irregular surface lacking normal joint surface. This lack of cartilage causes inflammation and pain in the joint.

A few other causes of arthritis can be rheumatologic/autoimmune conditions or infectious. Infectious arthritis is beyond the scope of this discussion.

Who gets ankle arthritis?

At OrthoArizona, we have found that most of our patients with ankle arthritis have had a history of injury. We also have some patients that have arthritis in other joints or it runs in their family. We do see some patients with rheumatologic or autoimmune arthritis, but advances in medications for some of these diseases have made these a little less common.

What are the symptoms of ankle arthritis?

Symptoms can vary, but most patients have pain and/or stiffness as their main complaint. Others may notice swelling or even mild warmth.

How is ankle arthritis treated?

Ankle arthritis treatment typically begins with conservative or nonsurgical care.

Conservative care options MAY include:

• Activity modifications/lower impact exercise
• Weight loss
• Ice or heat
• Bracing or orthotic devices
• Canes or walkers
• Over-the-counter or prescription strength medications to reduce inflammation or pain
• Supplements or alternative/complimentary medicine
• Injections

Surgical treatments MAY include:

• Removal of unstable or loose bone/cartilage fragments to improve mechanical symptoms
• Correcting alignment to slow progress of the arthritis
• Ankle fusion – Making the two main bones of the ankle joint grow together to eliminate the joint and hopefully the pain
• Ankle replacement

Ankle Replacement

Question: I have heard of knee and hip replacements for arthritis. Is it possible to replace the ankle?

Answer:

It is possible to perform an ankle replacement to treat ankle arthritis. The current FDA-approved implants are very successful, with about 90% lasting for 10 years. Fewer individuals have had ankle replacements because ankle arthritis is less common than arthritis of the hip or knee. Numerous developments in ankle replacements have occurred over the last 40 years.

Some Things To Consider

Individuals with ankle arthritis who have failed conservative treatments such as medications, injections, activity modifications or bracing are candidates for ankle replacement. Patients with diabetes/nerve problems, poor circulation, morbid obesity, severe ankle deformity or osteoporosis, ankle infection and smokers are not good candidates.

Another option besides ankle replacement surgery is ankle fusion. With a fusion, the surgeon attempts to get the ankle joint bones to grow together. This eliminates motion in the ankle joint itself, in an attempt to relieve pain. Ankle fusion is a tried-and-true operation, but does sacrifice motion. Some studies show that gait is significantly altered while others suggest that fusing the ankle may put more stress on surrounding foot joints.

Discuss each option with your orthopaedic surgeon to find the best plan for you.

Ankle Fusion

What is a Fusion?

In orthopedic surgery, a fusion operation is where the surgeon attempts to get two bones (that are normally connected by a joint) to grow together. Fusions of the foot and ankle may be performed for arthritis or instability. In the case of arthritis, there is usually severe pain at the affected joint and there may not be an option for a joint replacement. If the surgeon can prepare the bones appropriately and stabilize them, the bones typically will grow together (or “fuse”) almost like a broken bone does. If the arthritic and painful joint is eliminated, the pain is usually significantly decreased.

Why are Fusions performed?

Fusions performed for instability are usually reserved as a last resort after reconstruction ligaments or tendons fail.

When a physician and patient decide on fusion of a joint, they are essentially trading stiffness and pain relief instead of the previous pain or instability they once had. Function is typically not normal, but much better than a painful arthritic or unstable joint. Fusions are typically done in smaller joints in the body that are not amenable to joint replacement.

There are advantages and disadvantages to fusion operations. Your physician will discuss these with you during your visit.