Ankle arthritis can be due to many causes. Congenital deformities, trauma, infection, ankle instability, inflamatory arthritis, avascular necrosis and aging. Regardless, the end result is loss of articular cartilage and resultant pain with varying degrees of stiffness and loss of function.The initial treatment relies on weight loss,arthritis medications, use of walking aids (canes, braces,shoe modifications) and decreased activity. Injections with steroids can give temporary relief/ Injections with Hyaluronic acid (Synvisc) can also help but its use is OFF LABEL.
Total Ankle Replacement: Artificial ankle replacement has had a checkered history particularly if compared to the relatively predictable results of knee or hip replacement. Early failure rates (7-10 % ) and up to 15% at 3 years were not for the faint of heart. The recent availability of the S.T.A.R. ankle replacement has changed everything. In selected patients, a success rate of over 90% at 3 years+ is attainable.
I have been performing ankle replacements for over 14 years with the success rate comparable to that reported in the literature.I am well versed and eperienced in revision ankle replacement surgery as well as post replacement fusions. I have been trained in performing total ankle replacements for the following total ankle replacements:
**N.B. Not everyone with ankle arthritis is a candidate and the selection process as well as assessment of the risks and benefits of the procedure is crucial.
***OTHER SURGICAL OPTIONS:
- Ankle debridement (open or arthroscopic) for bone spurs, impingement and loose bodies.
- Arthrocopic procedures for discrete injuries (drilling/microfracture)
- Osteochondral grafting from the knee or a fresh frozen allograft of bone and cartilage for “discrete” lesions of the talus.
- Distraction arthroplasty. i.e. the placement of an external fixator (erector set) where the joint is distracted or pulled apart. Allowing the cartilage in some cases to reconstitute itself.
- The Gold standard, until recently, has been ankle fusion which has a 95% fusion rate but a 100% loss of any remaining motion and the possibility of other joints in the foot becoming symptomatically arthritic by 10 years postoperatively. In patients with stiff ankles or a history of infection this is still the top choice.