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Ankle Arthritis

What is the cause?

It can occur because of simple wear and tear (Primary osteoarthritis), but can also be following damage to the joint from trauma.

This could either be as a result of multiple ligament injuries or a fracture. Inflammatory arthritis such as rheumatoid arthritis can also be a cause.

Ankle replacement was first described in 1968, even before the first knee replacement but the early joints failed. Ankle replacement has become more popular and more reliable over the last ten years but the current joints do not have long term follow up. The ankle replacement used by Mr Sturdee up until June 2014 was the DePuy Mobility. After this time he uses the Scandinavian Total Ankle Replacement STAR.

All ankle replacements from April 2010 are entered into the national joint registry just like hip and knee replacements. All patients are very closely followed up so and will be followed up for life.
Post operatively patients are in a plaster cast for two weeks non weight bearing and then a walker boot until six weeks post op and during this time weight bearing is allowed and range of movement exercises are begun.

What are the symptoms?

1. Non operative treatment
Pain killers can be used including anti inflammatories. Splintage and a walking stick can also be used but all of these treatments are only effective in early disease and may not give complete pain relief.

2. Injection
Local anaesthetic and steroid can be injected into the joint in early disease but the injection usually does not give long term relief.

3. Ankle arthroscopy
This is keyhole surgery and a camera is placed into the joint together with small instruments and can be used in mild arthritis to tidy up any cartilage flaps that can irritate the joint and contribute to the symptoms.

4. Ankle fusion (arthrodesis)
This is the gold standard surgical treatment for ankle arthritis that is very effective at abolishing pain from the ankle arthritis. The joint is surgically fused usually with two screws and as a result no movement will occur at the joint.
There are two ways to achieve a fusion. It can be done as an open procedure but more and more fusions are now being done using arthroscopic techniques. The advantage of an arthroscopic ankle fusion is that the complications are less and in particular the risk of non-union is less.
Following an ankle fusion patients are placed into a below knee plaster for six weeks and will be non-weight bearing. A walker boot is then used for a further six weeks during which time some weight bearing is allowed.

5. Total ankle replacement
Ankle replacement like fusion aims to abolish the pain from the ankle arthritis but it has the advantage of maintaining movement in the joint. This results in a more normal walking pattern. There are contraindications to ankle replacements and for some people fusion will be the only option.