For patients with severe ankle arthritis, pain is just a part of daily life. While therapies such as medication, physical therapy, and bracing can alleviate discomfort for some patients, for others the pain is unrelenting. In these cases, it’s good to know that there are options to eliminate the pain. Here, we discuss the surgical options to treat severe ankle arthritis with one of the area’s most sought after ankle specialists, BCOS’s Dr. Andrew Peacock. In a broad conversation, we talk about when it’s time to consider surgery, what happens in both ankle fusion and ankle replacement surgery, the pros and cons of both procedures…and on the subject of ankles, a little sidebar on high-profile ankle injuries in the NFL.
What is severe ankle arthritis?
There is cartilage throughout the ankle that “cushions” the joint. In “end stage” or severe ankle arthritis, the cartilage is worn down to the point that there is bone-on-bone grinding or contact within the joint. Obviously, that situation can create pain, limit mobility, and ultimately impact activity level and quality of life.
What causes severe ankle arthritis?
Ankle arthritis is typically caused by injury to the ankle. This is different from knee and hip arthritis that can be caused by simple wear and tear. Ankle arthritis is usually the result of some kind of trauma such as a bad fracture, or chronic trauma such as repeated ankle sprains.
How do you know it’s time for a patient to consider surgical options for severe ankle arthritis?
Typically, we try to explore all reasonable non-surgical treatments such as anti-inflammatories, physical therapy and bracing before recommending surgery for ankle arthritis. But, when the ankle pain gets to be severe despite the other therapies and is impacting a patient’s quality of life, it’s probably time for surgery.
What are the surgical options for severe ankle arthritis?
The two options are ankle fusion surgery (also known as arthrodesis) and ankle replacement surgery (also known as arthroplasty). For many years, ankle fusion was the only surgical option. But recent advances in technology and surgical techniques have made ankle replacement another viable option for patients with end-stage ankle arthritis.
How do you determine whether ankle fusion surgery or ankle replacement surgery is the best option for a patient with end-stage ankle arthritis?
To determine which procedure is best for a patient, I take into consideration a wide variety of factors including the patient’s age, overall medical picture, and activity level. I also analyze the patient’s advanced imaging, such as a CT scan or MRI, and conduct a thorough physical examination. Putting all of these findings together, I discuss the alternatives and considerations with the patient and ultimately we choose the option that will provide the best level of activity and long-term quality of life.
What happens in ankle fusion surgery?
In ankle fusion surgery we prepare the joint, remove the remaining cartilage, and “fix” the ankle joint in place using surgical materials, such as plates and metal rods. This eliminates the bone-on-bone contact that causes arthritic pain.
Will a patient still be able to move their foot and ankle after fusion surgery?
The biggest misconception with ankle fusion surgery is that the foot and ankle are going to be too stiff to function. While we are eliminating the up and down motion of the ankle, there are 32 other joints responsible for motion in the foot and ankle. The foot actually makes up for a lot of the motion. If I fused someone’s ankle and had them walk down the hall, it would be hard to tell if they had a fused ankle. Of course, there would be some stiffness, but there is more mobility than most patients expect.
What are the pros and cons of ankle fusion surgery?
For ankle fusion, the pros are pain relief, longevity (often a better option in younger patients), and ultimately satisfied patients. The cons include less natural motion and longer recovery from surgery.
What happens in ankle replacement surgery?
The ankle joint is made up of three bones, the tibia, the fibula, and the talus. In a replacement, two highly polished cobalt chrome steel parts – the tibial component and a talar component – along with a highly cross-linked polyethylene component are used to replace the ankle joint.
What are the pros and cons of ankle replacement surgery?
For ankle replacement, the pros are pain relief, faster recovery time, preservation of motion, more natural motion, and patient satisfaction is often faster than ankle fusion. The main drawback is the finite lifespan of the implants, meaning the components may need to be revised in the future. However, recently published literature shows long-term survivorship for the replacement to be as high as 93%, which is significantly higher than previous generations.
What is an upside of both procedures?
For those patients who struggle with the severe discomfort of ankle arthritis, their lives are impacted by that pain every day. With both ankle fusion and ankle replacement, we are able to eliminate that pain, restore vitality, and improve quality of life.
Are there any other surgical options for ankle pain that can help patients?
Yes, in fact, ankle arthroscopy is a common surgical procedure that can be used for both diagnosing and fixing some ankle ailments.
What is ankle arthroscopy and what’s it for?
Ankle arthroscopy is a minimally invasive surgical procedure in which we use small incisions to insert a fiber-optic camera and small surgical tools to operate in and around the ankle joint. It can be used to both diagnose and repair damage to the ankle. For diagnostic purposes, ankle arthroscopy allows us to see inside the joint in a way that imaging alone cannot. The arthroscopic procedure also provides an opportunity to address and repair a variety of issues within the ankle, while still minimizing incisions, scarring, and recovery time. For example, we can use ankle arthroscopy to remove debris, such as a bone chip or torn cartilage, from inside the joint. We can also use it to more accurately evaluate the extent of damage to an injured ligament and possibly repair it.
Since we’re talking about ankles, we have to ask this question. Football fans around the country cringed when they saw Cowboy’s quarterback, Dak Prescott’s ankle injury. As an ankle specialist, what did you think when you saw that?
As far as ankle fractures go, the mechanism that he had was one of the worst, as you could tell from watching it.
Washington Redskins Alex Smith’s ankle fracture (if you’re familiar with that) was about as bad as it gets as far as the fracture and the recovery. But it was more the type of fracture you see when someone falls off of a building or is in a auto accident. It’s not typically a sports injury.
Dak’s was a rotational injury as well as an open fracture. It is the type of ankle fracture in which the prognosis is not as good as if he had twisted his ankle the other way. But, will somebody like Dak Prescott be able to play again after an injury like that? He should be able to.
The irony of course was the day he returned, Alex Smith was also back on the field for the first time.
Ankles and people can be resilient!
They can.
Specialized Treatment for Ankle Arthritis and Pain
Bucks County Orthopedic Specialists can address your foot and ankle issues, arthritis, and pain, providing all the surgical options discussed in this blog. Dr. Andrew Peacock is a fellowship trained podiatric surgeon who specializes in the surgical and non-surgical treatment of foot and ankle problems, including complex trauma, arthroscopy, rear foot and ankle reconstruction, and total ankle replacement. For a comprehensive evaluation and treatment plan, call (215) 348-7000 to schedule an appointment with Dr. Peacock.
