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Ankle Arthritis: Joint Replacement or Fusion?

Unlike hip and knee arthritis which occur from degenerative “wear and tear” as we age, ankle arthritis in most cases is post-traumatic, usually occurring 10-20 years after a previous injury; affecting people much sooner in life during their 40’s, 50’s, and 60’s. 

The pain, physical disability, and emotional changes that ensue following the onset of ankle  arthritis are considerable, and progressively become more debilitating over time.

Conservative treatment for ankle arthritis focuses on minimizing symptoms with external bracing, physical therapy, serial injections, and oral prescriptions, among other modalities. However,  minimally invasive ankle arthroscopy and arthrotomy are also performed in some cases, in an attempt to provide longer last pain relief and “buy patients more time” before inevitably; advanced reconstruction becomes necessary.  However, it is important to note that none of these treatments are able to reverse the condition after its onset.

Advanced reconstruction entails either a joint sparing procedure “Total Ankle Arthroplasty” (also referred to as Total Ankle Replacement”) or a joint destructive procedure “Ankle Fusion”.  Ankle replacement allows patients to keep their joints range of motion, walk normally, and regain the ability do perform activities such as hiking, biking, and swimming, that they used to enjoy pain free.  In contrast, ankle fusion permanently removes the ankles motion, alters walking gait, and predisposes adjacent joints close by (knee, subtalar, etc.) to arthritis over time. 

The choice to keep or lose ankle motion seems straightforward.  However, historically fusion was the preferred treatment choice due to poorer ankle replacement designs and outdated surgical techniques.  However, more recent studies over the past decade have clearly shown improved survivorship, better function, and higher patient reported outcomes for ankle replacement compared to ankle fusion.  This is due to improved implant designs, and improved training among surgeons during fellowship.

Unfortunately, many foot and ankle surgeons in the United States remain either untrained or uncomfortable with performing total ankle replacement, which is a very technically demanding procedure.  It is not uncommon for these providers to recommend ankle fusion (requires 8-12 weeks of non-weight-bearing postoperatively) to patients who are ideal candidates for an ankle replacement.  Notably, not all patients are appropriate candidates for total joint replacement.

I quote all my total ankle patients 90% implant survival at 10 years.  The most common risks for replacement surgery include delayed wound healing, and minor numbness on the front of the leg.  Typically surgery is performed in an outpatient ambulatory surgery center and patients go home that same day.  The following day, weightbearing and physical therapy begin for most patients.

If you are considering an ankle replacement or fusion, it is important to schedule your appointment with a Fellowship-Trained, Podiatric/Orthopedic Surgeon to better understand the best treatment options available to you.  Fellowship-Trained, Podiatric/Orthopedic Surgeons have spent an additional year of intensive, advanced surgical training, in order to provide patients with the highest quality of care.

Author
Calvin J. Rushing, DPM, AACFAS Fellowship-Trained, Podiatric Surgeon with specialty in advanced reconstruction, including total ankle replacement, arthroscopic cartilage repair, deformity correction, minimally invasive surgery, sports injuries, and trauma.

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