Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis

Osteoarthritis (OA) is a condition that affects joints and their cartilage, causing structural and functional deterioration. While it commonly affects joints like the knee and hip, ankle osteoarthritis is less discussed due to its lower occurrence. Two main treatments for ankle OA are total ankle replacement (TAR) and ankle arthrodesis (AAD).

AAD, also known as ankle fusion, is a widely used approach for ankle OA. It often brings about significant pain relief and functional improvement, allowing patients to resume their daily activities. TAR, on the other hand, serves as an alternative to AAD and has seen advancements over the years, offering better outcomes including reduced pain and improved function. Despite their effectiveness, both procedures have drawbacks.

Ankle fusion, although a conventional method, can alter walking patterns and potentially lead to OA in adjacent joints. TAR shows promising short and mid-term results but requires further investigation for long-term effects and poses challenges for surgeons due to its complexity.

Kim et al. conducted a similar study comparing TAR and AAD for severe ankle arthritis in 2016. This study’s main finding aligns with theirs: both TAR and AAD show similar effectiveness and safety in certain aspects. While Kim’s study found TAR patients had more re-operations and complications, these results didn’t show a significant difference between the two procedures. This difference could be due to the inclusion of more recent studies in our analysis, suggesting potential advancements in surgical techniques over time.

Both TAR and AAD have seen improvements in recent years, with advancements in surgical techniques and increased surgeon experience leading to better outcomes.

In summary, while each treatment may excel in different aspects, it’s challenging to determine superiority between TAR and AAD as there was no statistically significant difference found. The limitations identified in this analysis suggest the need for larger sample sizes and improved search strategies to minimize bias and variability. Further research is essential to thoroughly evaluate and compare the effectiveness and safety of TAR and AAD.

Do you have more questions? 

What is arthritis?

Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis.

  1. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility.
  2. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs.

Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery.

It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.

 

What is ankle arthritis?

Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.

What causes ankle arthritis? How do you get arthritis in your ankle?

In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia.

 

In many of these cases, an initial fracture/impaction injury results in uneven force dissipation across the ankle joint. This causes the ankle to be overloaded in certain area. After years of walking on this unevenly distributed joint, the cartilage starts to wear thin, and inflammation ensures. 

Is ankle arthritis common? How common is ankle arthritis?

Ankle arthritis is less common that larger weight bearing joints such as the knee or hip. The incidence of ankle arthritis is approximately 30 per 100,000 people. Global approximation is roughly 1% of the population. 

What does arthritis in ankle feel like?

Often patients will experience pain around ankle joint. This is most commonly with weight bearing, walking, or exercises. Swelling at the joint line is very common. Over time the joint will become stiff, and range of motion will be lost. If this goes on long enough, the alignment of the joint will change, and a progressive deformity will ensue. The natural history of all arthritis is to slowly and chronically progress, with worsening pain exacerbation episodes. 

How do you diagnose ankle arthritis? how is ankle arthritis diagnosed?

A surgeon will obtain a thorough history and perform a physical examination. If there is a convincing clinical presentation, we will confirm our suspicion with X-rays and advanced imaging. Additional testing may be required. 

Does ankle arthritis show up on X-ray?

Yes. Most of the time we are able to detect arthritis on X-rays. In the cases of very focal disease, or early arthritis, additional advanced imaging may be required (MRI / CT scans).

What does ankle arthritis look like on an X-ray?

Ankle arthritis will show up as narrowing of the joint space at the ankle joint line. There may also be formation of new bony spurs. In severe cases the ankle will start to drift medially or laterally, resulting in deformity.

How to treat arthritis in ankle arthritis? What can be done for ankle arthritis? What can I do for arthritis in my ankles?

 

The treatment of ankle arthritis is divided into non-operative and operative techniques. 

 

In vast majority of patients, we initially encourage non-operative treatment. The goal of non-operative treatment is to avert or delay surgery. No intervention can “cure” arthritis.  We try to maximize your time with a natural joint. Most of these strategies are aimed at keeping you strong and allowing you to cope with the pain from ankle arthritis. Non-operative interventions include activity modification, shoe modifications, weight loss, bracing, walking aids, physical therapy, and pain medications / anti-inflammatories. You can try turmeric and topical capsaicin as natural remedies. Some patients report improvements in pain. You should maintain optimal levels of Vitamin D and Calcium. This is important for bone and cartilage turnover. Icing and elevation can help with swelling related symptoms.

 

Once these options are exhausted, we typically turn in injection options. This includes cortisone injections, Hyaluronic Acid injections, Platelet Rich Plasma (PRP) injections, and Mesenchymal Stem Cell (MSC) injections. Cortisone is a strong anti-inflammatory and can provide temporary relief of pain symptoms. Recent literature suggests having too many cortisone injections can hasten joint deterioration. See the article below. Thus, frequent cortisone injections are not ideal. Hyaluronic Acid injections act as lubrication and can help with pain symptoms. These tend to provide temporary pain relief and return of function. PRP are injections where we take blood, spin out the red blood cells, and run the plasma layer through a filtrate. This concentrates growth factors, inflammatory singling molecules, and immune modulators. This can help stabilize cartilage and provided more long-term pain relief. MSC is a more invasive procedure where we harvest stem cells from your pelvic. We then use a special centrifuge to separate the stem cells, and this is then injected into the arthritic joint. These cells secrete the same proteins that are found in your plasma. However, since we are injection cells, the effect of this injection tends to be longer. 

 

See the article below that summarizes these non-operative arthritis management strategies. 

 

Once all non-operative options have been exhausted, and you are no longer able to cope with ankle arthritis, surgical options are indicated. Continue reading for further information on how surgery can be helpful for treating ankle arthritis. 

 

https://journals.lww.com/jbjsjournal/abstract/2021/11170/rapidly_destructive_hip_disease_following.2.aspx

https://journals.sagepub.com/doi/full/10.1177/2473011419852931

 

Do ankle braces help with arthritis? Will an ankle brace help arthritis?

Yes. Most ankle arthritis braced work by reducing motion at the ankle joint. This helps prevent excessive motion and helps reduce pain. However, it can worsen ankle stiffness. Use it sparingly. Try to maintain ankle range of motion with stretches / exercises,

What surgery is done for ankle arthritis?

Once all non-operative options have been exhausted, and you are no longer able to cope with ankle arthritis, surgical options are indicated. Continue reading for further information on how surgery can be helpful for treating ankle arthritis. 

 

There are many surgical approaches to treating ankle arthritis. This depends on several factors. This can be patient factors such as underlying medical conditions, level of activity, goals of treatment, and expectations. Joint related factors also come into play. This includes how severe the arthritis is, whether there localized or global disease, severity of arthritis, presence of deformity, and involvement of surrounding soft tissue structures. Furthermore, concomitant foot deformity must also be considered. 

 

Early ankle arthritis, that is well localized, in young active healthy patients, is amenable to debridement with ankle arthroscopy. This is a minimally invasive procedure where a camera is inserted into the joint, and areas of arthritis are debrided away. This can provide pain relief, more range of motion, and long-term symptom control for patients with early ankle arthritis. See the ankle arthroscopy section for more information regarding these options. Speak to one of our experts if you think you may be a candidate. 

More extensive arthritis is typically treated with two main options: fusion (arthrodesis) or replacement (arthroplasty). Both options have their benefits and pitfalls. It is critical to have a discussion with your surgeon to determine which option is right for you. 

 

Ankle fusion (arthrodesis) is considered the gold standard for cases of severe ankle arthritis. It has been the go-to procedure for decades. Here we expose the joint, remove any residual cartilage, and oppose the talus bone to the end of the tibia bone. These two bones heal to one another, forming one bony structure. Functionally the joint is eliminated. There is no motion across the joint anymore. However, there is also no pain. 

 

Ankle replacement (arthroplasty) is a newer procedure that has been advancing quickly over the last 2 decades. Replacement surgery is much more involved than ankle fusion. It provides pain relief similar to fusion surgery. However, it allows us to maintain motion at the ankle joint. This is thought to prevent neighboring foot joints from deteriorating. The recovering and healing form this is more difficult. 

 

Ask one of our experts if you are a candidate for one of these procedures.

How is an ankle fusion done? How does ankle fusion work?

In order to do an ankle fusion, we first make the decision to do it using a traditional open incision, or arthroscopically (though a camera). This depends mainly on how severe the arthritis is. In either case, we expose the joint and removed any residual cartilage. Bony ends of the talus and tibia are exposed. All debris is removed. We then Make perforations that facilitate healing. We then oppose the bony ends of the talus and tibia in a functional position. We use screws or plates to compress and hold this bony apposition. The incisions are closed.

After the procedure the ankle is casted, and you are kept non-weight bearing for a minimum of 6 weeks. After that point, we start the rehab process. 

How is ankle replacement done? How does ankle replacement work?

In order to perform an ankle replacement, we often will utilize advanced imaging and patient specific instruments. This requires a CT scan before the procedure. Custom cutting jigs will be 3D printed. These improve the location of bony cuts and reduce operative time. 

 

We make an incision in the front of your ankle, avoiding nerves and vessels. We dissect down to the joint, preserving soft tissues. We apply and secure 3D printed custom cutting jigs. These are secured. We then cut the tibia and talus to accommodate metal implants. Once cuts are made, we remove excess bone and debris. We apply trial implants to ensure sizing and tension. Once we have determined the correct size implants, we place metal components in the tibia and talus. We then place a high-density polyethylene component. 

 

At this stage we stress test the ligament structures. If there is ligament deficiency, we may perform a reconstruction acutely, or stage this to a later time. Similarly, if there is a foot deformity this may be addressed at the time of surgery or staged to a later time. 

 

All incisions are closed and a cast is applied. This can be present for 2-4 weeks. After this point, rehab is initiated. 

What is recovery like after an ankle replacement (arthroplasty)?

 

Once the surgery is complete, you are placed into a cast. The cast is required for minimum of 2-4 weeks. We will remove the sutures 2-3 weeks post op. You will have to remain non-weight bearing for minimum of 2-4 weeks. Once the cast is removed, we can start weight bearing and rehab. Often, we will transition you to a rigid removable boot, to start weight bearing. This will be weaned as you progress in physical therapy. 

It will likely take 3-4 months before you feel that you can walk on the ankle comfortably. The fusion will continue to heal and remodel for over a year. Swelling will be present for at least 6 months. In some cases, swelling is present for over 18 month. It goes away eventually as you rehab. 

Is ankle replacement better than ankle fusion? Which surgery is better for ankle arthritis?

This is a difficult and complex question. For many decades, there have been similar outcomes in terms of post operative pain, function, and satisfaction when comparing ankle replacement to ankle fusion. Both offer similar pain relief and function. However, ankle replacements preserve motion. Additional, ankle replacements are high risk surgeries. There is higher risk of complications such as infection, fracture, nerve / vessel injury, and requirement for further surgery in the future. 

 

Historically, ankle fusions were the surgery of choice for vast majority of patients. However, as ankle replacement implants evolve, there is a paradigm shift. We are starting to see better outcomes for replacement patients compared to fusion. Patients are happier, more functional, and have more motion. There is also a lesser risk of neighboring joint degeneration because ankle motion is preserved. This means that there is a lesser risk of the rest of the foot deteriorating because of a fused ankle. Have a look at the below study which demonstrates this. 

 

https://pubmed.ncbi.nlm.nih.gov/36375147/

Can ankle arthritis be cured? Can arthritis be removed from ankle? How to cure arthritis in the ankle?

For all arthritis, there is no “cure”. No medication or surgery will give you the cartilage you had in your twenties. Nothing can reverse the deterioration of the joint. Non-operative treatments are aimed at decreasing pain and improving function. However, the arthritic process continues to progress. Surgery is aimed at eliminating or replacing the joint. This does not restore cartilage, but instead allows for the joint pain to be eliminated. 

Can you get arthritis of your ankle?

Yes. See the FAQs above for more information. 

Can arthritis cause swollen foot and ankles?

Yes. This is a very common symptom of ankle arthritis. You can get swelling in your ankle and in the foot. 

Can a sprained ankle cause arthritis?

Most ankle sprains do not result in ankle arthritis. However, if the ligaments are severely torn due to injury, or there are recurring injuries, this can lead to ankle arthritis. 

Can arthritis in knee cause swelling in ankle?

Yes. As the knee joint swells, it can cause pressure on the vessels in the back of the knee. This generates back pressure which causes ankle and foot swelling. 

Can hip arthritis cause ankle pain?

This is very unlikely. There are most probably two separate issues. 

Can knee arthritis cause ankle pain?

Typically knee arthritis does not cause ankle pain. Occasionally, in severe knee deformities, ankle pain results due to abnormal loading of the ankle. 

Can rheumatoid arthritis affect your ankles? Can rheumatoid arthritis cause swollen ankles?

Yes. See the FAQs above for more information. 

Is walking good for arthritis in the ankle? Is cycling good for ankle arthritis?

Generally, low impact exercise is considered helpful for arthritis related pain. This includes walking, cycling, swimming, etc. High impact exercise can exacerbate pain and cause progression of arthritis. This includes running, jumping, and repetitive impact-based exercises. 

Is exercise good for ankle arthritis?

Generally, low impact exercise is considered helpful for arthritis related pain. This includes walking, cycling, swimming, etc. High impact exercise can exacerbate pain and cause progression of arthritis. This includes running, jumping, and repetitive impact-based exercises. 

Can I run with ankle arthritis?

Yes. However, high impact activities, such as running, are more likely to exacerbate ankle arthritis. 

What are the signs of arthritis in your ankles? What does arthritis in the ankle look like?

Pain on range of motion, swelling, and stiffness are the most common signs of ankle arthritis. You gait may be affected, causing a limp. 

What are the symptoms of ankle arthritis? what does arthritis feel like in your ankle?

Pain at the ankle joint line with range of motion, walking, and weight bearing. The pain tends to be worse with acute activity and progresses slowly over years. Often the pain will come in exacerbations. These will become more frequent and severe. 

Does cracking your ankle cause arthritis?

No. Most ankle cracking are tendons moving over one another. This does not result in arthritis of the ankles. Thus far, there have not been any convincing evidence that cracking any joint results in arthritis. 

How to ease arthritis pain in ankle? how to get rid of arthritis in ankle? How to help ankle arthritis?

There are several non-operative ways to improve ankle pain. See the treatment FAQs above.

How to know if you have arthritis in your ankle?

A clinician must perform a history and examination of the ankle. Once this is done, confirmatory studies such as X-rays will be done. Once the work-up has been completed, we can determine the cause of ankle pain. There are several causes for ankle pain. 

How to prevent arthritis in ankle?

Most ankle arthritis is caused by trauma (fractures), and thus are difficult of avoid. However, proper shoe wear, avoidance of high impact activity, avoiding of high-risk activities, and weight reduction, can all help reduce the risk of ankle arthritis. 

Is ankle arthritis a disability?

Ankle arthritis can cause disabling pain and functional limitations. 

What helps arthritis in ankles? What to do for arthritis in ankle?

See the treatment FAQ above for more information. 

What is the best ankle support for arthritis?

A semi rigid AFO can help reduce pain in the ankle from arthritis. Rocker bottom shoes can also be helpful. You may also find a removable semi-rigid ankle brace useful for pain and stability. See one of our experts to get a prescription and orthotist recommendation. 

What type of arthritis affects the ankles?

Most commonly, ankle arthritis is post-traumatic. See the above FAQs for more information. 

Does ice help arthritis in ankle? Does elevation help with ankle arthritis? How to reduce swelling in ankles due to arthritis?

Yes. Especially if there is swelling. We recommended icing and elevation for 15 min while there is swelling. Try to do this as much as possible to help reduce symptom duration and frequency. 

Can massage help ankle arthritis?

Some patients find pain relief with massage treatments. We recommend trying it if you are interested. See a reputable licensed provider. 

Can physical therapy help ankle arthritis?

Yes. The goal of physical therapy is to help obtain and maintain range of motion of the ankle. A physical therapist will give you a home program. It is important to try and these home exercises every day. When you go to see the therapist, they will try to do those activities you cannot do on your own at home. This includes using modalities such as massage, TENS, shockwave, ultrasounds, and manipulations.

Can ankle arthritis cause leg pain? Can ankle arthritis cause shin pain?

Some patients report radiation of ankle arthritis pain into the leg or shin. However, most of the pain is typically prepared at the ankle joint line. 

Can ankle replacement help arthritis?

Yes. See the treatment FAQs above for more information. 

Can I feel arthritis in ankle malleolus?

Patients with arthritis of the medial or lateral malleolus will often complain of pain on that corresponding side. 

 

Can I still play basketball with arthritis in my ankle?

Yes. However high impact activity such as this is likely to exacerbate arthritis pain. 

Can knee arthritis cause pain in hip and ankle?

Knee arthritis pain tend so radiate distally, but the pain is rarely perceived in the ankle or in the hip. You may feel radiation of pain into the shit. Rare does it radiates to the ankle.

 

Can psoriasis arthritis affect the ankle?

Yes

Can rheumatoid arthritis affect the ankle?

Yes. 

Can treadmills cause ankles arthritis?

No. There is no evidence that this is the case. However, read all safety warnings when using any equipment. Improper use can result in injury. 

What causes ankle arthritis? How do you get arthritis in your ankle?

In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia.

What is ankle arthritis?

Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.

What is arthritis?

Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis.

  1. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility.
  2. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs.

Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery.

It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.

A seasoned orthopedic surgeon and foot and ankle specialist, Dr. Mohammad Athar welcomes patients at the offices of Complete Orthopedics in Queens / Long Island. Fellowship trained in both hip and knee reconstruction, Dr. Athar has extensive expertise in both total hip replacements and total knee replacements for arthritis of the hip and knee, respectively. As an orthopedic surgeon, he also performs surgery to treat meniscal tears, cartilage injuries, and fractures. He is certified for robotics assisted hip and knee replacements, and well versed in cutting-edge cartilage replacement techniques.
In addition, Dr. Athar is a fellowship-trained foot and ankle specialist, which has allowed him to accrue a vast experience in foot and ankle surgery, including ankle replacement, new cartilage replacement techniques, and minimally invasive foot surgery. In this role, he performs surgery to treat ankle arthritis, foot deformity, bunions, diabetic foot complications, toe deformity, and fractures of the lower extremities. Dr. Athar is adept at non-surgical treatment of musculoskeletal conditions in the upper and lower extremities such as braces, medication, orthotics, or injections to treat the above-mentioned conditions.