Ankle Arthritis and Total Ankle Replacement
Your ankle is a tough and durable part of your body. But even the toughest body parts can wear out over time or become injured, causing pain and stiffness and affecting the ability to walk. Total ankle replacement is one of several treatments for an ankle joint that has worn out.
Symptoms and Causes
What causes arthritis of the ankle?
The bones of your ankle are covered by a perfectly smooth and resilient substance known as cartilage. It is cartilage that allows the ankle joint to move smoothly and painlessly. Arthritis is a disease process in which the cartilage becomes thinner and rougher. When this occurs, joint motion becomes stiff and painful.
Arthritis can occur in any joint in the human body. Arthritis is more likely to occur in joints that have been injured or damaged. Some ankle injuries are severe such as broken ankles that require surgery. Other ankle injuries are less severe, such as sprains, but may cause a problem if they occur over and over. Both of these types of injuries can result in ankle arthritis.
Some people develop arthritis without having had an injury in the past. This “wear and tear” type of arthritis affects the knee and hip more commonly but can also affect the ankle.
Management and Treatment
How is arthritis of the ankle treated?
People who suffer from arthritis in the ankle can get some relief in a number of different ways. Over-the-counter pain relief medicines, especially those that reduce swelling such as ibuprofen, can help. You might also try good shoes, shoe inserts, pads, and arch supports, physical therapy, and a brace or cane. If these aren't helping, your doctor may inject medicine, such as a steroid, directly into the ankle joint.
When might surgery be suggested?
If the simple, non-surgical treatments fail to control the pain, it is reasonable then to speak with an orthopaedic surgeon about the surgical options. If the arthritis is mild, symptoms may be improved using arthroscopic techniques. Arthroscopy generally involves using a small camera to evaluate the ankle and small instruments to remove damaged tissue. Arthroscopic procedures use small incisions and are minimally invasive. But these techniques are only effective in early stages of arthritis.
When the arthritis is more advanced, more extensive surgery may be necessary. An ankle fusion is a common treatment for severe ankle arthritis. In this procedure, the two bones that normally move in the ankle are transformed into one solid bone that no longer moves. This is accomplished by removing all the remaining cartilage, packing the joint with bone, and holding it still with metal plates and screws. Although this type of surgery is generally very successful at decreasing pain and improving function, it does result in a stiffer ankle that moves up and down less.
What is an ankle replacement surgery?
Another treatment for severe ankle arthritis besides fusion is total ankle replacement. In ankle replacement surgery, an artificial ankle joint is implanted to replace the damaged cartilage. There are a number of artificial ankle devices your surgeon can choose from. They are generally made from metal and plastic parts, and are very strong.
Total ankle replacement surgery is a good alternative to ankle fusion surgery in some patients with ankle arthritis. Unlike a fusion, the ability of the ankle joint to move up and down is maintained. This ability to preserve motion is considered an advantage over ankle fusion. But like all joint replacements, an ankle replacement can wear out over time and does not withstand high-impact activity well.
Who should NOT have ankle replacement?
An ankle replacement is not the best option for every patient with ankle arthritis. Ankles that are severely deformed or unstable or have had an infection in the past may be better treated with fusion. Similarly, patients with serious medical problems such as diabetes, obesity, or problems with blood supply are generally not good candidates for ankle replacement.
Who performs an ankle replacement?
Total ankle replacement surgery is a complicated procedure and should only be performed by an orthopaedic surgeon who specializes in it. Recovery from ankle replacement may take 6 to 12 months. There are also risks with ankle replacement. Risks include infection, problems healing the incision, and gradual loosening or wearing out of the metal and plastic. If these complications develop, additional surgery is usually needed.