Ankle Osteoarthritis Surgery

If ankle arthritis symptoms are severe enough to interfere with daily activity, surgery may be recommended.

Five types of surgeries are used to relieve ankle arthritis. Which surgery is recommended will depend on the severity of the arthritis, the patient’s lifestyle and expectations, and the surgeon’s experience and expertise.

Ankle Fusion (Ankle Arthrodesis or Tibiotalar Arthrodesis)

Fusing together the tibia, fibula, and talus bones can increase ankle stability and eliminates bone-on-bone friction, thereby decreasing pain. The downside to ankle fusion is that it significantly reduces ankle flexibility. This lack of flexibility can put strain on the knee and foot joints, possibly making them more prone to osteoarthritis.

Ankle Replacement (Ankle Arthroplasty)

Like a knee replacement, an ankle replacement replaces the natural joint surfaces with artificial ones. The top surface of the talus bone and the bottom surfaces of the tibia and fibula bones are removed and replaced with artificial components separated by a soft, flexible polyethelene pad.

Prosthetic designs have improved over time, but in general, ankle replacement is challenging because of the joint’s unique physiology. Success rates are lower than in knee and hip replacements.

People with ankle replacements are advised against high-impact activities such as running and jumping. Lower impact activities, such as swimming, biking and hiking, are normally okay.

Ankle Fusion vs. Ankle Replacement
The most commonly performed surgeries for severe ankle arthritis are ankle fusion and ankle replacement. Current research shows:

• In general, ankle fusion is safer more reliable. ¹ S.L. Haddad, J.C. Coetzee, R. Estok, K. Fahrbach, D. Banel, L. Nalysnyk. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis: A Systematic Review of the Literature. The Journal of Bone & Joint Surgery. 2007 Sep;89(9):1899-1905. ^{, 2} Maffulli N, Longo UG, Locher J, Romeo G, Salvatore G, Denaro V. Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Br Med Bull. 2017 Dec 1;124(1):91-112. doi: 10.1093/bmb/ldx042. Review. PubMed PMID: 29186357.
• Ankle replacement potentially offers better range of motion and higher patient satisfaction, but is less reliable. ¹ S.L. Haddad, J.C. Coetzee, R. Estok, K. Fahrbach, D. Banel, L. Nalysnyk. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis: A Systematic Review of the Literature. The Journal of Bone & Joint Surgery. 2007 Sep;89(9):1899-1905. ^{, 2} Maffulli N, Longo UG, Locher J, Romeo G, Salvatore G, Denaro V. Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Br Med Bull. 2017 Dec 1;124(1):91-112. doi: 10.1093/bmb/ldx042. Review. PubMed PMID: 29186357.
• About 10% of people who undergo ankle fusion need a second surgery, compared to 20% of people who undergo ankle replacement. ² Maffulli N, Longo UG, Locher J, Romeo G, Salvatore G, Denaro V. Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Br Med Bull. 2017 Dec 1;124(1):91-112. doi: 10.1093/bmb/ldx042. Review. PubMed PMID: 29186357.

As more research becomes available, surgeons will become better able to identify which patients are most likely to have good results from ankle replacement.

Ankle Debridement

This surgery 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. Evidence suggests this surgery is best suited for people whose symptoms are caused by bone spurs or other tissues that impinge the joint. ³ Hassouna H, Kumar S, Bendall S. Arthroscopic ankle debridement: 5-year sur- vival analysis. Acta Orthop Belg 2007;73: 737–40. As cited in Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019 Jun 25;35. [Epub ahead of print] PubMed PMID: 31237341.

Ankle Arthrodiastasis

The goal of ankle arthrodiastasis is to provide the cartilage enough time and space to repair itself. ⁴ 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. The procedure involves stretching 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.

This surgery is not common. Clinical studies suggest more than half of arthrodiastasis patients experience decreased pain and improved function. ⁵ van Valburg AA, van Roermund PM, Marijnissen AC, van Melkebeek J, Lammens J, Verbout AJ, Lafeber FP, Bijlsma JW. Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle. Osteoarthritis Cartilage. 1999 Sep;7(5):474-9. PubMed PMID: 10489320. ^{, 6} van Roermund Peter M; Marijnissen, Anne CA; Lafeber, Floris PJG. Joint distraction as an alternative for the treatment of osteoarthritis. Foot and Ankle Clinics. 2002 Sept;7(3)515-527 ^{, 7} Paley, Dror; Lamm, Bradley M; Purohit, Rachana M; Specht, Stacy C. Distraction Arthroplasty of the Ankle—How Far Can You Stretch the Indications? Foot and Ankle Clinics.2008 Sept;13(3)471-484 This surgery is often an attractive option for younger patients with post-traumatic arthritis who want to try to avoid ankle arthrodesis (fusion) and ankle replacement.

Cartilage Transplant

When ankle arthritis is caused by a sizable, well-defined defect in the ankle’s cartilage—for example, a 1 cm ² Maffulli N, Longo UG, Locher J, Romeo G, Salvatore G, Denaro V. Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Br Med Bull. 2017 Dec 1;124(1):91-112. doi: 10.1093/bmb/ldx042. Review. PubMed PMID: 29186357. area of cartilage missing due to a trauma—cartilage transplant surgery may be an option. During this surgery, new cartilage is grafted into place. The hope is that, over time, the new cartilage will establish itself in the ankle and replace the missing cartilage.

Most cartilage transplants for ankle arthritis use cartilage taken from outside the patient, such as a fresh cadaver. Like ankle arthrodesis, this surgery is typically offered to younger patients who want to avoid ankle fusion or ankle replacement.

This procedure is relatively new and less researched than other ankle surgeries. Early research suggests mixed results. ⁸ Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019 Jun 25;35. [Epub ahead of print] PubMed PMID: 31237341. ^{, 9} French MH, McCauley JC, Pulido PA, Brage ME, Bugbee WD. Bipolar Fresh Osteochondral Allograft Transplantation of the Tibiotalar Joint: A Concise Mid-Term Follow-up of a Previous Report. J Bone Joint Surg Am. 2019 May 1;101(9):821-825. doi: 10.2106/JBJS.18.01001. PubMed PMID: 31045670.

A person with end-stage ankle arthritis is advised to find an experienced surgeon who can advise which surgery, if any, may be appropriate.

Learn about which types of doctors treat arthritic conditions such as ankle osteoarthritis in Arthritis Treatment Specialists