Ankle arthritis is
relatively uncommon compared to hip and knee arthritis.
Ankle arthritis is most
often post-traumatic that is; following an injury. Although ankle sprains are
incredibly common, ankle arthritis is relatively rare, therefore we do not
believe that ankle sprains in general cause arthritis.
Patients with ankle
arthritis complain of pain anteriorly, this may be associated with swelling,
deformity and limitation of activities particularly walking.
- The patient may
walk with a limp.
- They will generally have pain anteriorly, medially and
- The ankle joint will be stiff when compared with the opposite side.
- Generally they will have satisfactory movement in the subtalar and
- Plain x-rays taken weight bearing of the ankle, AP, lateral and mortise view.
- CT scanning and MRI
scanning are useful.
- CT scanning will show the presence of cysts and MRI scan
will show early arthritis often before it appears on plain x-rays.
- Nonsurgically, ankle arthritis can be treated by weight loss, cushioning shoes
and anti-inflammatory medication.
- A cortisone injection may provide transient
- I am not a firm believer in PRP injections or stem cell injections.
there is deformity and one side of the joint is preserved, an osteotomy of
either the distal tibia or the calcaneus may buy the patient time.
distracting the joint using an external fixator may provide relief, in general
this technique has not been popular in this country.
- For end-stage
arthritis, the options are really replacement or fusion.
- Unfortunately ankle
replacement has not been as successful as hip replacement. (for example in this
country in 2010 there were 450 ankle replacements performed. In 2016 there were
only 130 performed. Compare this to 50,000 hip replacements and approximately
50,000 knee replacements. Whilst the Internet is replete with stories of
successful ankle replacement unfortunately our experience in this country and
that of our colleagues in New Zealand has not been as favourable).
- The problems
with ankle replacement include; the formation of cysts around the prosthesis
which can occur very early (as early as two years). The other problem is of
- Ankle fusion whilst
sounding unattractive is a good option in the active patient as long as the
surrounding joints are in good condition.
Many techniques of
ankle fusion have been described. The procedure can be performed open or
arthroscopically. Ankle fusion is however not without its problems. The surgery
requires hospitalisation and a period of immobilisation of approximately 10
weeks the first six of which are nonweight bearing.
The fusion rate in most
series is between 80 and 90%. Smokers are known to have an increased risk of
- The other concern with
ankle fusion is that the surrounding joints will wear out prematurely.
This is less of a concern if one is fusing a 75-year-old as if one is fusing a
Naturally fusing the ankle does not make
it normal. Gait studies performed on patients with ankle fusion do
suggest a slower cadence of gait and a shortened stride length. Nonetheless
most patients with a successful ankle fusion are happy in the sense that they
have less pain and better function.