The majority of people with ankle osteoarthritis will never need surgery. However, if ankle arthritis symptoms are severe enough to interfere with daily activity and other treatments do not succeed, surgery may provide relief. Surgeries to relieve ankle arthritis are described and discussed below.

Ankle debridement is done to remove inflamed tissue (synovium), smooth out rough cartilage, trim away bone spurs, and remove loose bits of cartilage or bone that may be irritating the joint. This may be performed using arthroscopic or open surgery.

Ankle arthrodiastasis stretches out the ankle joint, increasing space between the talus and tibia bones. During surgery an external fixation device is secured to the talus and tibia with metal pins and wires. The device is worn for approximately 3 months, during which time the patient can walk on the affected ankle. The goal of ankle arthrodiastasis is to provide the cartilage enough time and space to repair itself.26

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While this procedure is still relatively new in the U.S., clinical studies so far show most arthrodiastasis patients experience decreased pain and improved function.27,28,29 This surgery is often an attractive option for younger patients with post-traumatic arthritis who want to avoid more invasive surgeries such as ankle arthrodesis (fusion) and ankle replacement, which alter natural ankle motion. Ankle arthrodesis and ankle replacement may be recommended, however, if symptoms persist.

Ankle arthrodesis (tibiotalar arthrodesis or ankle fusion) fuses together the tibia, fibula and talus bones of the ankle joint, thereby eliminating bone friction, decreasing pain and increasing stability. For decades arthrodesis surgery has been the most common and reliable surgery to address end-stage ankle arthritis. The downside to ankle arthrodesis is that it significantly reduces ankle flexibility, and this lack of flexibility can put strain on adjacent joints (e.g. the foot and knee), possibly making them more prone to osteoarthritis.

Ankle replacement (ankle arthroplasty) replaces the natural ankle joint surfaces with artificial ones. The bottom surfaces of the tibia and fibula bones and the top surface of the talus bone are removed and replaced with artificial components separated by a polyethelene pad.

  • Fixed-bearing ankle replacement has two artificial components, as the polyethelene pad is attached to the artificial tibial component
  • Mobile-bearing ankle replacement has three artificial components, and the polyethelene pad, while secure, is not fixed to either component.

Ankle replacement is challenging because of the ankle’s unique physiology, and success rates tend to be lower than in knee and hip replacements.

Ankle Arthrodesis versus Ankle Replacement

Many experts debate whether ankle arthrodesis or ankle replacement is better for ankle arthritis patients. Clinical studies vary widely, in part because the exact method of ankle arthrodesis and ankle arthroplasty (i.e. what type of surgical technique and specific components are used) can vary depending on the surgeon and patient.

One 2007 study30 compiled data from 49 different studies involving more than 2,100 patients. The findings are in the table below. More than two-thirds of patients had good or excellent results. For patients with poor results, reoperation to make adjustments is not uncommon, as indicated by the percentage of revision surgeries.


Result Ankle Arthrodesis
(1262 patients)
Total Ankle Arthroplasty
(852 patients)

Excellent

31%

38%

Good

37%

30.5%

Fair

13%

5.5%

Poor

13%

24%

Revision Rate

9%

7%

Notable advances in ankle arthroplasty have occurred in the past 20 years and improvements continue to be made. A person with end-stage ankle arthritis is advised to find an experienced surgeon who can advise which surgery, if any, may be appropriate.

References

  1. Kluesner AJ, Wukich DK. Ankle arthrodiastasis. Clin Podiatr Med Surg. 2009 Apr;26(2):227-44. doi: 10.1016/j.cpm.2008.12.006. Review. PubMed PMID: 19389596.
  2. See Full References
Further Reading: Exercising with Arthritis
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