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.

5 types of surgery used to treat ankle arthritis (1)

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

What is a bone spur?

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.

To prevent fractures in weakened areas of bone - especially those filled with fluidsubchondral cystsinside the ankle joint - an injection of bone marrow (from cells taken from the patient) may be indicated.

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.

The disadvantage of ankle fusion is that it significantly reduces the flexibility of the ankle. This lack of flexibility can put a lot of stress on the knee and foot joints, making them more susceptible to arthritis in the future.

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.

Osteocartilage grafts are reserved for very large defects or when other attempts to repair the cartilage have failed.

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.

Ankle replacement has advantages and disadvantages. On the one hand, it provides a greater range of motion and greater satisfaction for the recipients. On the other hand, an ankle fixation is safer and more reliable, and half of the people require additional surgery compared to a joint replacement.

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.

10 fonts

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts in our articles. Read oureditorial processto learn more about how we fact-check and ensure the accuracy, reliability and dependability of our content.

  1. Hsu A, Gross CE, Lee S, Carreira DS.Extended indications for foot and ankle arthroscopy.J Am Acad Orthopaed Sur.January 2014;22(1):10-9. doi:10.5435/JAAOS-22-01-10

  2. Ulici A, Balanescu R, Topor L, Barbu M.Modern treatment of simple bone cysts.J Z Inside. 2012;5(4):469-73.

  3. Yasui Y, Hannon CP, Seow D, Kennedy JG.Ankle Arthrodesis: A Systematic Approach and Literature Review.The world of J Ortop. 2016;7(11):700-8. doi:10.5312/wjo.v7.i11.700

  4. Medda S, Al'Khafaji IM, Scott AT.Ankle arthroscopy with microfracture in the case of osteochondral defects of the talus.Technik Artrosc. 2017;6(1):e167-74. doi:10.1016/j.eats.2016.09.013

  5. Fansa A, Drakos M, Cabe T i in.Results of treatment of osteochondral lesions of the talus with a mixture of BioCartilage and bone marrow aspirate concentrate.Foot ankle orthopedics.luty 2018;2018:2473011418S00049. doi:10.1177/2473011418S00049

  6. Bisicchia S, Rosso F, Amendola A.Osteocartilage allograft of the talus.Iowa Ortop J.2014;34:30-7.

  7. Wynes J, Kaikis AC.Current advances in ankle arthrodesis.Clin Podiatr Med Surg. 2018;35(4):467-79. doi:10.1016/j.cpm.2018.05.006

  8. Castagnini F, Pellegrini C, Perazzo L, Vannini F, Buda R.Joint-sparing treatment for early osteoarthritis of the ankle: current procedures and future prospects.J Exp Ortop. 2016;3(1):3. doi:10.1186/s40634-016-0038-4

  9. Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V.complete bone replacement.International Doctors Dtsch. 2015;112(11):177-84. doi:10.3238/arztebl.2015.0177

  10. Lawton CD , Butler BA , Decker RG , Prescott A , Kadakia AR .Total ankle arthroplasty vs. ankle arthrodesis - comparison of results from the last decade.J Orthop Surg Res.. 2017;12(1):76. doi:10.1186/s13018-017-0576-1

5 types of surgery used to treat ankle arthritis (2)

ByNeal Blitz, DPM, FACFAS
Neal Blitz, DPM, FACFAS, is a certified podiatrist and the creator of the bunion surgery.

See our editorial process

Get to know our professional medical advice

Was this page helpful?

Thank you for your answer!

What is your opinion?


Top Articles
Latest Posts
Article information

Author: Kelle Weber

Last Updated: 21/10/2023

Views: 6182

Rating: 4.2 / 5 (53 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Kelle Weber

Birthday: 2000-08-05

Address: 6796 Juan Square, Markfort, MN 58988

Phone: +8215934114615

Job: Hospitality Director

Hobby: tabletop games, Foreign language learning, Leather crafting, Horseback riding, Swimming, Knapping, Handball

Introduction: My name is Kelle Weber, I am a magnificent, enchanting, fair, joyous, light, determined, joyous person who loves writing and wants to share my knowledge and understanding with you.