Overview

The most common cause of ankle arthritis is due to previous trauma although in some patients it may occur as part of the development of rheumatoid arthritis, haemophilia or gout. Ankle arthritis is the loss of the ankle joint’s cartilage lining and usually occurs over a period of years.  Regardless of the cause, the resulting narrowing of the ankle joint space between the shinbone and ankle bone and development of bony spurs, is the same.  The ankle becomes stiff, painful and may lock or grind.  Even though arthritis of the ankle is less common than that affecting the hip or knee, the results can be equally painful and debilitating.

If your arthritis is not too severe, simple measures such as losing weight, using walking aids and avoiding high impact activities can effectively treat it. Activities such as cycling, swimming and walking are encouraged.

When it becomes more severe, the next step is anti-inflammatories, painkillers, physiotherapy, orthotics, ankle bracing or a custom fitted splint.  Sometimes cortisone injections or a lubricant will be offered and may offer relief.

Process

When the above measures fail there are 3 main surgical options:

• Arthroscopic debridement
• Joint arthrodesis (fusion)
• Joint replacement

Arthroscopic debridement

This is a day procedure using keyhole surgery with a recovery time of around 6-12 weeks.  It is generally most suitable for early arthritis. Bone spurs and loose bodies are removed and irregularities in remaining cartilage tidied up. There is around a 70% improvement rate but in 2% of patients, the process may actually accelerate the deterioration requiring further surgery sooner than expected.

Ankle arthrodesis

If you have severe arthritis this surgical technique is the most suitable.  It involves removing bone from the both the shin and ankle bones and holding them together with screws. The ends of the bones then grow or fuse together.  Even though ankle motion is eliminated, the adjacent joints compensate and allow up to 30% of motion to return.  The increased load across the other joints can cause arthritis to develop in those as well and some patients will require additional fusion in the future.

Recovery Times

Time off work

Benefits

• Fusion is reliable in providing long term pain relief for younger patients with high physical demands. It results in a limp free gait and allows return to more physical work
• Preserves ankle motion
• Relieves painful symptoms
• Allows return to physical activities

Risks

• There can be wound problems depending on age and general health
• Further surgery may be required sooner than expected
• There is a failure rate of 2%
• You may require adjustment surgery in first 5 years
• Time off work may be extended depending on recovery

Dr. Rodda does not perform ankle replacement surgery. He prefers the more reliable and durable results of ankle arthrodesis (fusion).