Dr. Gold's Orthopedic Surgery Blog

Surgeon and Author, Dr. Stuart Gold,
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Is Ankle Surgery for Arthritis Common?

February 8th, 2011

Arthritis in the ankle may be caused by normal cartilage wear from activity or after a specific injury such as an ankle fracture resulting in post-traumatic arthritis. Ankle arthritis may also be caused by inflammatory conditions such as Lupus or Rheumatoid arthritis. In early stages, patients may experience little or no pain, and discomfort is usually attributable to activities that are high-impact or weight bearing. As the condition progresses, however, some patients may find that the pain does not abate even at night or is present even without weight placed on the joint. Ankle surgery for arthritis is far less common than surgery for other arthritic joints, such as knees or hips. However, there are three basic surgeries that can be an option for patients that do not respond to other treatments, such as splints and special shoes, steroid injections, weight loss or changes in activity levels.

The most commonly performed ankle surgery for arthritis is a debridement. This procedure is typically performed as day surgery on patients in the early stages of arthritis. It is normally an arthroscopic procedure, requiring a minimal incision. Most patients have a short recovery period and can begin placing weight on the ankle within an hour or two of surgery. The procedure has a success rate of 75 to 80 percent for improvement, with about a five percent chance that the debridement may actually worsen symptoms.

Arthroscopic ankle surgery for arthritis normally requires two incisions, each less than one centimeter in length. To perform the debridement, the surgeon uses a telescope and small instruments inserted through the incisions to remove any damaged cartilage or bone spurs. He then cleans and smoothes the surfaces of the bones.

Patients with arthritis of the ankle may also undergo fusion surgery. This involves removing the covering of the joint (cartilage) and placing it in position so that the bones will join together. The ankle must be kept in position while the bones fuse, and this is usually accomplished by screwing the two sides of the joint together. In some cases, a metal rod is inserted in the heel to compress the sub-talar and ankle joints. It generally takes about three to four months for the bones to fuse, but some patients may require a longer time for fusion to occur.

The third ankle surgery arthritis is joint replacement. This procedure is relatively new, so fewer of these operations have been performed than on other joints. Patients normally recover their range of motion, but the operation is unsuitable for those who are active in sports or who perform heavy-duty manual labor. In an ankle replacement, the surgeon removes the worn surfaces on the ends of the two primary bones. The articulation (joint) between the tibia and the talus gets replaced with contoured metal components. A spacer, typically made of polyethylene (a special type of plastic), is added between the two surfaces.

I hope this helps you better understand ankle surgery for arthritis.

Stuart

About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.

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