Ankle Arthritis

 

A great deal of research has been devoted to the treatment of ankle arthritis. In previous years, the only options included cortisone injection and fusion. Today, options available include ankle bracing, lubrication injections, arthroscopic joint cleanup and spur removal, joint distraction, ankle replacement and arthroscopic ankle fusion. With each of these treatment options, the differing needs of each patient can be considered and an individualized treatment can be arranged.

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Arrow showing arthritis of the ankle compared with stable contralateral ankle.

Bracing of the ankle is meant for those patients with limited arthritis and patients who are a poor surgical candidate. Bracing can be used to relieve a great deal of pain but does not deal with the underlying arthritic process.2anklearthritis

Lubrication of the joint is an injection therapy that was developed for the knee but we use in the ankle with great success. In cases of limited arthritis, lubrication of the joint can be used to delay the development of severe arthritis and control pain.

Arthroscopy of the ankle, or the use of a camera to look inside the ankle, is a simple and often very effective method of cleaning and decreasing the pain in the ankle. The procedure is done in an outpatient surgical center under local anesthesia with or without a small amount of sedation. The ankle is entered through small holes and the joint is checked. Any spurs, loose bone, scar tissue and the arthritis is cleaned. It is hard to return the ankle to its normal state, but a great deal of pain relief and improved function can be achieved with little to no downtime.

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Extra bone growth in the ankle as seen with arthroscopy Scar tissue in the anterior ankle as seen with arthroscopy
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Loose ankle ligament prior to therapy Capsular shrinkage of the ankle ligament
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Final ligament after shrinkage
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Note X-ray Exostosis
(yellow arrow) on the
Front of the Ankle
Open Image of Exostosis
(yellow arrow) on the
Front of the Ankle

Cartilage transplant is used to replace the damaged cartilage in an ankle with arthritis of only a part of the ankle. Bone and cartilage are taken from a fresh cadaver specimen and replaced in the ankle joint damaged area. The procedure is simple to perform and allows for dramatic relief of pain in patients who may only have been told they had fusion as an option.

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Region of Cartilage and Bone
Damage (bright white) in the
Ankle Joint
Visible Region of Cartilage and Bone
Damage (yellow arrow) in the
Ankle Joint
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Fresh Replacement Talus for
Harvest and Transplant of
Cartilage and Bone
Transplanted Cartilage and Bone
(yellow arrow) Just Prior to
Final Positioning Press Fit

Joint distraction of the ankle is performed with the use of an Ilizarov ring fixator to distract the joint. Lubrication injections are then used to decrease the abnormal stress in the joint. The concept behind distraction of the ankle is to allow the cartilage and bone to have a chance to rest and heal with no stress on the surface of the joint. The procedure is fairly simple but the fixator can be somewhat cumbersome. Total time for repair is usually 6 weeks to 12 weeks with use of the fixator.

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Distraction ankle with external fixation with Ilizarov ring

Ankle fusions are a last resort procedure and reserved for the most severe cases of arthritis. In patients who require high demand of their ankle and are active, replacement surgery is not a good option and fusion is still the ideal option. Often patients have no pain and return to a higher level of activity than prior to their surgery.

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Arthritis of the Ankle
with Poor Alignment
Ankle fusion with internal fixation

Ankle replacement has been tried for many years. A recent series of ankle implants have improved the outcomes of ankle replacement and decreased the rate of problems. Ankle replacements are limited in their use on patients at this time, but in the ideal candidate, they provide pain relief and improved function. Please refer to the ankle replacement for more information.

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Normal Left Ankle
Arthritis of Right Ankle
Noted by Decrease of Joint Space
Total ankle joint replacement

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