5 types of surgery used to treat ankle arthritis (2023)

ankle arthritisThis is a condition in which the cartilage in the ankle joint breaks down, causing pain and limiting movement. Progressive arthritis can cause bone cysts and the formation of bone spurs (osteophytes). If conservative therapies - such as ankle braces, padded insoles, anti-inflammatory drugs, cortisone injections and physical therapy - do not provide relief, surgery may be considered if the pain and loss of mobility severely impair your quality of life.

Depending on the severity of your symptoms, surgical options can range fromarthroscopic('keyhole') to more invasive procedures such as total ankle replacement.

Ankle debridement and exosectomy

Ankle arthritis is characterized by the development of bone spurs, usually in the front of the joint. Over time, the spurs can become quite large and extend to the outside (circumference) of the joint, where they are likely to break off and leave loose bone fragments. The cartilage surrounding the joint will also begin to roughen and wear down, causing pain and making movement much more difficult.

cleaning the ankleand exosectomy are procedures used to "clean" a joint in order to restore itRange of motionand reduce pain. Both drugs are used to treat mild to moderate ankle arthritis and are usually performed on an outpatient basis.

The purpose of debridement of the ankle joint is to remove inflamed tissue in the joint space (synovium), smooth rough cartilage and extract loose pieces of cartilage or bone. Exosectomy specifically refers to the removal of bone spurs that block movement.

Both procedures can be performed arthroscopically, using narrow instruments and a flexible tube to access the ankle through a series of small incisions. If the damage is extensive or difficult to access,open operationcan be made with a larger incision.

While these procedures can provide significant relief, bone spurs can renew themselves over time. Secondary scar tissue may also develop and interfere with joint function. Additional surgery may be necessary in these cases.

Arthrodesis of the ankle joint

ankle arthrodesis, also known as tibiotalar arthrodesis or ankle fusion, is a surgical technique used when debridement is unable to provide stability or lasting pain relief. This is usually considered for minimal ankle degeneration or misalignment of the ankle bones.

Connecting the main bones of the leg (so-calledtibiamifibula) Howtalusankle joint increases stability and eliminates bone-to-bone friction, thus reducing pain. Depending on the severity of the disease, surgery may be arthroscopic or open.

To perform arthrodesis, the surgeon will make an incision in the ankle, cleaning and compressing the bone to correct minor misalignments. The bones will then be permanently attached with plates, nails, screws, or other hardware.

cartilage repair

If the articular cartilage in the joint space is significantly reduced, cartilage repair may be considered. It is usually performed in the case of a significant, well-defined loss of ankle cartilage.

In the simplest type of repairmicrocracks, the damaged cartilage is removed and small holes are created in the talus, allowing blood and cells to enter the holes to form blood clots. The clots gradually turn into a type of scar tissue called fibrocartilage. Microfracture surgery can be performed arthroscopically in an outpatient setting.

Those with more extensive cartilage damage may benefit from a newer product called BioCartilage. A powder consisting of collagen, proteins and growth factors is mixed with stem cells taken from the patient's blood or bone marrow and transferred to small holes drilled in the talus.

The last surgical option is aosteochondral graft. For this procedure, cylinders of cartilage taken from the patient's knee (or cadaver) are transplanted directly onto the talus. This is an invasive procedure and often requires breaking part of the bone to access the damaged area.

Arthrodesis of the ankle joint

Ankle arthrodesis has proven to be a viable surgical option for people with severe ankle arthritis who wish to avoid ankle replacement.

The procedure involves stretching the ankle joint to increase the space between the talus and tibia. During surgery, an external fixation device is attached to the talus and tibia with metal pins and wires. The device is worn for about three months, during which time you can walk on the affected ankle.

The purpose of ankle arthrodesis is to give damaged cartilage time and space to regenerate. Stem cells taken from the body (usually from the pelvis) can then be used to 'regenerate' the cartilage (new cartilage).

While ankle arthrodesis is attractive to young people who want to avoid more invasive procedures, it is only effective in about half of people.Even so, it does not destroy underlying tissues and may help preserve future treatment options.

ankle arthroplasty

ankle arthroplasty, also known as ankle replacement surgery, involves replacing parts of the fibula, tibia and talus with removable artificial prostheses. During this operation, the upper surface of the talus and the lower surfaces of the tibia and fibula are removed and replaced with artificial elements separated by a soft polyethylene cushion. Modern prostheses consist of porous metallic materials stabilized with or without cement.

Although prosthetic designs have improved over the last few decades, ankle replacement remains a challenge due to the joint's multidirectional physiology. Success rates tend to be lower than for knee and hip replacements.

Recovery times are invariably longer and require moreextensive physiotherapyand rehabilitation. People with ankle prostheses are advised not to engage in strenuous activities such as running and jumping. Swimming, cycling and walking are generally acceptable.