Total Ankle Replacement

What is Osteoarthritis?

Also called primary or degenerative arthritis, OA is a condition that affects the joints of the body. This process develops over the years due to damage and wear suffered by the cartilage lining. It is the most common cause of arthritis (joint inflammation) and can affect any joint in the body. The most commonly affected are the hands, hips, knees, neck and lower back.

OA is a chronic and slowly progressive disease, and to date there is no medical cure for it. Current medical treatment is mainly directed towards pain relief, and loses effectiveness over time as the disease progresses. As the disease reaches its more advanced stages the cartilage lining has been completely lost and the bones of the affected joint are in contact. This is called “bone on bone” contact; at this stage the friction in the joint is significant and causes a great deal of pain.

Symptoms of Osteoarthritis

Patients who suffer from this condition usually complain of:

  • Pain- Joint may hurt during or after movement.
  • Tenderness- Your joint may feel tender when you apply light pressure to it.
  • Stiffness- May be most noticeable in the morning or after a period of inactivity.
  • Loss of flexibility- May not be able to move the joint through its full range of motion.
  • Grating sensation- A grating sensation may be heard or felt with joint movement; this is characteristic of the bone on bone stage of the disease.
  • Bone spurs- Extra bits of bone, which feel like hard lumps, may form around the affected joint.


Non-Operative Treatment

Arthritis in its mildest form may not need any treatment whatsoever except simple activity modification – avoiding impact activities such as jumping – and recommending activities that are more controlled with less impact such as swimming, cycling, and walking on cushioned surfaces. Anti-inflammatory medications may be utilized as well. For patients with stiff and painful joints, bracing is another form of treatment.

Operative Treatment

Surgery performed for arthritis of the foot and ankle include arthroscopic debridement, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).

Arthroscopic Debridement
Arthroscopic surgery may be helpful in the early stages of arthritis. A flexible, fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin. The arthroscope is fitted with a small camera and lighting system, as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the problem areas. Small instruments at the end of the arthroscope, such as probes, forceps, knives, and shavers, are used to clean the joint area of foreign tissue, inflamed tissue that lines the joint, and bony outgrowths (spurs).

Arthrodesis or Fusion
Arthrodesis fuses the bones of the joint completely, making one continuous bone. The surgeon uses pins, plates and screws, or rods to hold the bones in the proper position while the joint(s) fuse. If the joints do not fuse (nonunion), this hardware may break. A bone graft is sometimes needed if there is bone loss. The surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the wing of the pelvis) to replace the missing bone.

Arthroplasty or Joint Replacement
In arthroplasty, the damaged ankle joint is replaced with an artificial implant (prosthesis). The joint is replaced with a combination of metal and high grade plastic (polyethylene). In addition to providing pain relief from arthritis, ankle replacements offer patients better mobility and movement compared to fusion. By allowing motion at the formerly arthritic joint, less stress is transferred to the adjacent joints. Less stress results in reduced occurrence of adjacent joint arthritis.

Ankle replacement is most often recommended for patients with:

  • Advanced arthritis of the ankle
  • Destroyed ankle joint surfaces
  • An ankle condition that interferes with daily activities