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Arthritis Special Report

Arthritis in Your Ankle? You've Got Choices!

For people with severe arthritis of the hip, knee, and shoulder, joint replacements have become commonplace. Many patients don't know, though, that joint replacement is also an option when arthritis strikes the ankle. Many patients with ankle arthritis continue to opt for a motion-limiting procedure called joint fusion, but recent research suggests ankle replacement is at least as effective as fusion -- with the added benefit of preserving the ankle's flexibility.

As a major weight-bearing joint, the ankle is susceptible to osteoarthritis (OA) -- the gradual breakdown of cartilage within joints. In the early stages of ankle arthritis, ice and acetaminophen are usually effective at reducing pain. For more advanced arthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections can help relieve pain. When these conservative treatments fail, surgery is an option.

Joint fusion for ankle arthritis
People with severe ankle arthritis have traditionally opted for joint fusion surgery (arthrodesis). During this procedure, surgeons completely remove the ankle joint by pulling back tendons and scraping out all soft tissue and cartilage. The fibula (calf bone), tibia (shin bone), and talus (foot bone) are then fused together with metal screws.

Fusion is very effective at stopping pain and stabilizing the bones so that they do not rub against one another. But there are several significant drawbacks. The ankle remains permanently stiff, restricting range of motion. Over time, arthritis may also develop in areas of the foot as other joints compensate for the ankle's loss of motion. And because the ankle joint has been completely removed, it may be difficult to bend down, climb stairs, or walk on uneven surfaces. Fusion also affects your gait, because one leg becomes shorter than the other. Some patients find that they need a cane or an orthopedic shoe insert for walking.

Total ankle replacement for ankle arthritis
Total ankle replacement -- called ankle arthroplasty -- was developed in the 1970s as an alternative to joint fusion. The procedure, which entails removing the arthritic joint and replacing it with an artificial one, fell out of favor because the artificial joints then in use malfunctioned frequently and wore out quickly.

Today, artificial ankle joints are far more sophisticated and effective than past devices. The newest joints make use of a special porous coating that allows bone to grow into it to secure the joint. Current ankle devices also have more maneuverable components for better joint function, and the materials are much more durable than before.

In the past few years, the FDA has approved three new ankle replacement devices, and research on these new artificial joints suggests that the outcomes of ankle replacement and joint fusion are similar. A recent analysis of 49 clinical trials, published in the Journal of Bone and Joint Surgery, compared the results of 852 ankle replacements with 1,265 joint fusion surgeries and found that most patients who received artificial joints -- nearly 70% -- were generally happy with the results, a percentage comparable to those getting joint fusion. Longevity was also similar: After five years, 7% of ankle replacement patients needed a second operation (mostly to tighten loose materials), compared with 9% of joint fusion patients. The majority of all surgeries -- replacement and fusion -- lasted beyond 10 years.

However, when patients were asked to compare their arthritis symptoms before and after surgery, those with artificial ankles reported a far superior range of motion. Studies show that people with severe ankle damage from rheumatoid arthritis and gout also benefit from ankle replacement.

Posted in Arthritis on June 28, 2010


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