Definition
Ankle arthritis, more properly, although infrequently, called ankle arthrosis, is a degenerative condition in which the ankle (tibio-talar) joint wears out. The cartilage that lines the joint thins or wears away altogether, bone spurs (osteophytes) form around the edges of the joint, the lining of the joint (synovium) becomes inflamed and the joint may become deformed. A number of factors can cause ankle arthritis: genetic factors, inflammatory conditions and gout, for example, but in the ankle it often follows previous fracture or injury, sometimes sustained years earlier. As the condition progresses it causes increasing pain, swelling and stiffness, usually worse with activity. The ankle may gradually become deformed.
Treatment
Early or mild ankle arthritis can be helped by simple measures such as losing weight, pain killers, changing activity patterns, physiotherapy, steroid injections and use of an ankle brace.
More moderate disease may respond to arthroscopic debridement (‘key-hole surgery’) or surgery to realign the ankle (supramalleolar osteotomy).
Advanced ankle arthritis is best treated by either total ankle replacement or ankle fusion (arthrodesis).
The advantage of ankle replacement is that it retains some flexibility in the joint and therefore puts less strain on the other joints of the foot than a fusion. The downside is that ultimately the replacement will wear out and need to be revised to either another replacement or a hindfoot fusion.
The advantage of ankle arthrodesis is that, once it’s fully healed it lasts indefinitely but with the downside that it leaves the ankle stiff and may put more strain on other joints.
There is little to choose between the procedures in terms of pain relief, risks and complications or recovery time, and at the moment there is no good evidence as to whether ankle replacement or fusion is the better operation. The general view is that ankle replacement may be better for some patients while ankle fusion may be better for others.
Shared decision making: The choice of operation should therefore only be made after a discussion between the patient and surgeon as to the pros and cons of each strategy and how they might be suited to the individual pateint's needs.