Surgery for Ankle Arthritis
Ankle arthritis in early stages may respond to non operative management.
This consists of:
- Rest and avoiding certain activities
- Anti-inflammatory medication
- Special braces or splints
- Cortisone injection
When non operative treatment is exhausted, then surgery is indicated.
The type of surgery for ankle arthritis is determined by:
- How bad is the arthritis? Mild arthritis can be treated arthroscopically (see below). Severe arthritis needs either fusion or replacement.
- How old is the patient? Young patients require a durable solution therefore replacement is not a good option.
The options are:
- Ankle arthroscopy: keyhole surgery
- Ankle fusion: stiffening the joint
- Ankle joint replacement: artificial joint
Ankle arthroscopy: keyhole surgery
This is keyhole surgery to remove any bony spurs on the front of the ankle through two tiny incisions in the skin. It is only suitable for patients where the arthritis is confined to the front of the ankle joint. Even then, the arthritis may over time progress to involve the rest of the joint.
This procedure then usually buys time before more major surgery and does not cure the arthritis.
An ankle arthroscopy and removal of spurs can be done as a day case or an overnight stay if you need it. It is only necessary to be on crutches for a few days. Once the wounds have healed then physiotherapy is started. You should allow one week off work for office duties and two to three weeks off for any physical work.
Ankle fusion: arthrodesis
This operation remains the gold standard. It permanently stiffens the joint and completely relieves pain in the vast majority of patients. It is very well tolerated and does not cause significant limitations as you might expect.
The operation removes the last remaining cartilage and the joint is then held together with screws and a plate until it heals like a fracture.
The main limitations are inability to run, and shoes are limited to a small heel. Walking and most gentle sports are unaffected.
This is major surgery and recovery is prolonged. You need to stay in hospital two days and on crutches in a moon boot for at least six weeks. Then you can walk on the boot for four to six weeks. It takes months for swelling in the foot and ankle to subside and up to six months to fully recover. Once the fusion is solid the pain disappears.
Ankle joint replacement: artificial joint
Ankle joint replacement is for advanced ankle arthritis. The replacement puts a metal surface on each side of the joint to cover the bone ends and a special plastic in between that acts like a shock absorber.
The advantages are that it preserves movement at the ankle which:
- protects nearby joints
- allows easier walking
The disadvantages are that:
- it is not suitable for young patients
- results are not quite as good as hip and knee replacements
- it will wear out in time and require revision or conversion to fusion
Joint replacement is not suitable for deformed or very stiff ankles, these need to be fused.
Complications of Surgery
You should be aware that all surgery has a risk of complications and this surgery is no different.
There are medical complications such as heart attack, stroke, drug reaction, blood clots in the legs or lungs and even death in very rare circumstances.
The chance of one of these happening is very small unless you have serious medical problems.
Surgical complications include:
- Infection: antibiotics are given before and after surgery to reduce the chance of infection, but cannot eliminate it.
- Nerve injury: can result from the small sensory nerves being caught up in scar tissue and may leave an area of numbness over the toe or occasionally an area of sensitivity.
- Bone healing: may be delayed or fail in rare cases and require another surgery.
- Poor position of the joint: in about one in thirty patients after fusion surgery, the position of the ankle is not quite right. This may require a repeat surgery to move the ankle up or down or even sideways.
- Progression of arthritis: other joints in the foot may develop arthritis over time and require a fusion or replacement surgery. If a simple arthroscopy has been performed, the ankle arthritis may worsen over time and require a fusion or replacement.
- Worn out joint replacement: if a joint replacement has been performed, it may wear out over many years and require a new one or conversion to a fusion.
- Wound healing: problems are rare and tend to happen in diabetics and smokers. If you do smoke you should stop smoking for at least four weeks around the operation.
Surgery is very effective in the majority of patients.
However it is possible, although very unlikely, to be made worse by surgery if a complication develops that cannot be easily fixed.
A more detailed discussion of your individual case will be made at the consultation.