Ankle arthritis is often caused by trauma to the ankle. That could be a previous fracture or ankle injury that occurred earlier in life. Degenerative changes, that happen as we age, rheumatoid arthritis, and congenital causes such as a birth defect, can also contribute to ankle arthritis later in life.
While knee and hip replacements have been mainstream for the past 50 years, ankle replacements have only become to approach the success of the hip and knee replacements in the past 15 years. If you have bad knee or hip arthritis, then your doctor will likely offer you a knee or hip replacement. On the other hand, if you have severe ankle arthritis, many doctors will still typically offer you an ankle fusion.
Long known as the gold standard for relieving painful arthritis in the ankle, an ankle fusion can be very effective in relieving pain, but it does reduce the flexibility and range of motion in the ankle and may affect a patient’s ability to participate in sports like running or biking. An ankle fusion involves welding the ankle joint, the tibia and talus bones, together and affixing it with plates and screws to stop any motion, thereby eliminating the pain. For young patients and those with a lot of deformity or neuropathy (numbness in their feet), ankle fusions are the best option and can be a huge benefit.
An ankle replacement, on the other hand, is a newer procedure and is appropriate for individuals with severe arthritis who have cartilage in the ankle that has worn away and left bone-on-bone arthritis. Ankle replacements are performed by removing a small amount of bone on each side of the joint and then putting a metal plate on the end of the tibia, a metal cap on the top of the talus, and then a piece of plastic in between the 2 pieces of metal to allow the natural joint motion. An ankle replacement has many benefits. It can allow the patient to have a pain free joint while retaining their motion and helping them go on to enjoy an active lifestyle. The joint replacement helps to maintain more natural motion in the ankle and that can help keep other joints in the knee or foot healthy too.
The reduction in pain coupled with the ability to have a more normal walking pattern can be life changing for individuals who get an ankle replacement. The expectation is that the ankle replacement will last for more than 10 years. Studies have shown 85-90% implant survival at 10 years. While ankle replacement is an excellent solution for people with painful and debilitating ankle arthritis, like any joint replacement, it has its limitations and indications. Sometimes the plastic piece may need to be replaced and sometimes small cysts form around the metal bone interface, and for that a bone graft can be helpful. Joint replacements are best performed in patients from 50-75 years old, but this range can be extended from 35-80 years old based on your lifestyle and your personal activity level. A thorough conversation with your doctor can help determine what is best for you.
Not everyone with ankle pain needs a replacement or fusion, just those patients with end stage ankle arthritis. For those patients with persistent ankle pain, an evaluation by a Foot and Ankle Fellowship trained Orthopedic Surgeon should be strongly considered.
Dr Keith Heier is a Foot & Ankle specialist at OrthoTexas in Carrollton.