Arthritis of the ankle is less common than the hip or knee but can be equally debilitating. Arthritis can occur following an old injury or can present without specific trauma.
Simple methods are often successful in the early stages such as pain killers, weight loss, shoe wear modification, physiotherapy and braces. Steroid injections can be diagnostic and may give some weeks or even months of relief. Once all these have failed to control the pain surgery can be discussed. Ankle arthroscopy may help in early arthritis but more advanced cases may require either an ankle fusion or an ankle replacement. Ankle fusion is a reliable, well proven method that allows a return to a high degree of function. The majority of patients are suitable for key-hole assisted (arthroscopic) surgery with rapid recovery. Many patients are concerned about the loss of motion but this loss can be surprisingly limited and most patients walk without a discernable limp.
Ankle replacement remains essentially an experimental procedure and some concerns remain about the long term outcome. They are not as successful as hip or knee replacements but in some patients (particularly with surrounding joint arthritis) it is a good operation.
Benefits of surgery
Both ankle fusion and replacement result in good pain relief and improved function.
Risks of surgery
The main risk of fusions is non-union, where the leg and ankle bones fail to heal together. The risk is approximately 10% following open fusions and less than 5% following arthroscopic fusions.
The main risks following ankle replacement are infections and loosening. Either of these complications are usually treated with a fusion (albeit more technically demanding and with a longer recovery than a primary fusion)
Both operations have a similar recovery protocol. A temporary cast is worn for 2 weeks followed by a removable boot for 2 months (in which you can weight bear). Full recovery takes 6 months.
Ankle fusion Ankle replacement