Orthopedics Foot and Ankle Surgery

Surgical management of ankle arthritis

Arthroscopic Debridement

A debridement for ankle arthritis is useful in the earlier stages of the arthritic process. It is normally performed as a day case procedure and generally patients can weight bear straight away on the operated ankle. The success rate for the procedure is in the region of 75%-80%. This corresponds to the percentage chance of improvement but not complete symptom resolution. On occasion it can take a number of months before this benefit is achieved. It needs to be borne in mind that there is approximately a 5% chance of significant symptomatic worsening following debriding an arthritic ankle. To find out more about ankle arthroscopy please select the phrase and the link will take you straight to the section.

Ankle Fusion

Ankle fusion involves preparing both sides of the joint back to healthy and bleeding bone. The arthritic joint lining is removed and the ankle joint is placed in a functional position and held there until the bone has grown across the joint and the ankle is thus fused. The ankle is held in position whilst the fusion is occurring and this is most commonly done with large screws which are buried beneath the skin. Occasionally a large metal rod may need to be inserted through the heel to compress the ankle and sub-talar joints (known as a double fusion). In cases where infection is present a device known as an Ilizarov frame may be used to compress the ankle joint and hold it in position until fusion has occurred. On average it takes three months for bone to be fairly soundly fused but on occasion it can take significantly longer.

Ankle Replacement

Ankle replacement involves replacing the two worn out surfaces with replacement highly polished surfaces and adding a high molecular weight polyethylene spacer between the two surfaces. Ankle replacement generally maintains the range of movement which a patient has pre-operatively. It is not suitable for heavy manual or sporting activities and probably has a ten year survivorship in the region of 85%. To find out more about ankle replacement please select the phrase and the link will take you straight to the relevant section.

The commonest surgical treatments for the severely arthritic ankle are either a fusion or a joint replacement. In less advanced or less symptomatic cases other surgical managements may work. To find out more about ankle fusion please select the phrase and the link will take you straight to the relevant section.

There is no precise definition of severe arthritis and a persons appreciation of pain, the commonest complaint in arthritis, is very subjective. However a clear example of severely arthritic symptoms would be ankle pain, continually present, resticted walking to 15 minutes only, responds little to painkillers and little changed or worsening over a number of months.

Often, though not invariably, such symptoms are associated with advanced x-ray changes such as loss of the joint space, thickening of the bone and outgrowths of bone around the joint known as osteophytes.

An osteoarthritic ankle showing spurs
of bone(or osteophytes) at both
the talus(1) and the tibia(2).

What causes ankle osteoarthritis?

Most people with degenerative change of the ankle joint have a history of some injury to the joint. This is most commonly due to a disruption of the joints smooth articular surface or congruity or a longstanding instability due to ligament injury.
It is less likely to occur without any identifiable cause (known as primary, or Idiopathic osteoarthritis, which is common in the knee and hip).