ANKLE & FOOT
Most patients are very familiar with hip and knee osteoarthritis (wear and tear arthritis). It is well known, surgically speaking, that end-stage disease can be treated with a hip or knee replacement. These are among the most successful surgeries in all of medicine in improving a patient’s quality of life.
However, few patients are aware of ankle arthritis, as it is far less common than hip and knee arthritis, and the ways in which it can be treated. Biomechanically, the ankle joint demonstrates a significantly decreased surface area as compared to other load-bearing joints such as the hip and knee. Therefore, ankle cartilage (the soft tissue lining of joints) and its properties are inherently different from hip and knee cartilage. The most common cause of ankle arthritis is after an injury like an ankle fracture or sprain. The remainder of other causes of ankle arthritis includes infection, rheumatoid arthritis, osteonecrosis, neuropathy, crystalline arthropathies (i.e. gout or pseudogout), dysplasia, and hemophilia. Whatever the cause, end-stage ankle arthritis is debilitating and severely impacts patients’ abilities to carry out their activities of daily life. In fact, end-stage arthritis of the ankle joint has been shown to be as debilitating as end-stage kidney disease and congestive heart failure.
Initial nonsurgical management of ankle arthritis consists of anti-inflammatory medications (i.e. ibuprofen, naproxen, etc.), bracing, ambulatory modifications, joint unloading and intra-articular corticosteroid injections. The two major surgical treatments for end-stage ankle arthritis that has failed to improve with non-operative measures are ankle fusion and ankle replacement. For various reasons including prolonged post-operative immobilization, increased stress on the remaining joints surrounding the ankle, altered biomechanics, loss of function including pain after prolonged activity, trouble walking on uneven ground, and difficulty while ascending and descending stairs, ankle replacement surgery has become an acceptable surgical option and has been evolving since the 1970s.
Since the first ankle was implanted, the advent of new surgical techniques, improved instrumentation combined with clinical experience has expanded the indications for ankle replacement surgery. Modern ankle replacement designs and techniques have demonstrated equivalent pain relief and better function when compared to ankle fusion. With this is mind, multiple studies have demonstrated that patients who undergo ankle replacement surgery experience significant improvements in pain, function, quality of life, as well as favorable patient reported outcomes.
Over the years, there has been concern about early failure of ankle replacements. However, recent literature has broadened indications for replacement as it has shown that younger patients and patients with deformity who undergo concomitant procedures addressing their deformity can have successful outcomes. However, long term implant survival is possible with the advent of newer designs that aim to recreate ankle kinematics in conjunction with improved clinical experience. Patient selection plays a crucial role in the success of patients’ outcomes. Patient goals, overall heath, activity level and every aspect of a patient’s medical history should be taken into account when recommending surgery for end-stage ankle arthritis. I take pride in maximizing non-surgical options for patients, individualizing their treatment plan and discussing ankle replacement surgery when clinically indicated. If you or a family member has any questions related to ankle replacement surgery, I am happy to set up a consultation.
Please see the link here to learn more about ankle replacement surgery here at Ortho Rhode Island.