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27.05.2014
Early or mild ankle arthritis is effectively treated with simple measures such as activity and lifestyle modification. When arthritis becomes more severe, the next step is painkillers and anti-inflammatory medications (if tolerated). However, as the underlying arthritic process is still present the response to surgery is variable. The main role of fusion is in younger patients with higher physical demands and in whom the ankle is the only affected joint.
Potential complications will be discussed with you but in general 90% of patients are satisfied. This is a relatively new procedure compared to hip and knee replacement and was not very successful until the creation of the latest generation of implants.
When compared with an ankle fusion, it provides a similar level of pain relief but the main advantage is that it preserves some of the pre-operative ankle motion. The potential complications will be discussed with you but in general 90% of patients are satisfied.
This brochure is a brief overview of the management of ankle arthritis and not designed to be all-inclusive.
The most common cause is previous trauma, but in some patients it may occur as part of a more widespread process such as rheumatoid arthritis, haemophilia, or gout.
There is a narrowing of the ankle joint space between the tibia (shin bone) and the talus (ankle bone) and bony spurs (osteophytes) develop. These include losing weight, using walking aids such as a walking stick, and avoiding impact activities such as jumping and running.


Around 70% will experience an improvement in symptoms but in around 2% of patients, the procedure may accelerate the deterioration.
The surgical technique involves removing bone from the tibia and talus and holding them together with screws. In most cases this can now be carried out using an arthroscopic technique through 4 or 5 small incisions around the ankle and lower leg. In these circumstances a successful fusion is very reliable in providing long-term pain relief that results in a limp free gait and allows return to more physical work. 3% of patients will require further surgery due to failure of the bones to fuse, and 10% may require surgery elsewhere in the foot for arthritis.
As a result, it reduces the subsequent stresses upon the knee and other joints in the foot.
This occurs in roughly 2-3% of patients per year and when it occurs, usually requires conversion to an ankle fusion.
5% will have a wound problem or fail early requiring fusion, and 10% may require further adjustment surgery in the first 5 years. Medications may be combined with physiotherapy, orthotics (shoe inserts), shoe modifications (rocker-bottom sole and high cut footwear), ankle bracing or a custom fitted splint.
The best option for an individual patient depends upon many factors including the severity of arthritis, the age and functional demands, and the presence of arthritis in other joints. The third component is a polyethylene (dense plastic) bearing which glides between the other 2. It is best suited for more elderly patients (over 65) with lower physical demands and a well-aligned ankle.


Ankle replacements are checked annually with x-rays, and occasionally small adjustment or maintenance procedures need to be performed.
After 5 years, the failure rate is 2% per year for all causes, 80% are still functioning after 10 years. Even though ankle arthritis is less prevalent than arthritis affecting the knee and hip, it can be equally debilitating and painful. Bone spurs and loose bodies can be removed, and irregularities in remaining cartilage may be tidied up.
Even though ankle motion is eliminated, adjacent joints compensate and may allow up to 30% of this motion to return. In more crooked ankles or following previous surgery, an open technique is usually still necessary. However as with all treatments, the degree and extent of relief varies from patient to patient. However the increased load across these other joints can cause arthritis to develop and up to 10% of patients will require fusion oi??i??f other joints at some stage in the future.



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