Surgery Options for Ankle Arthritis

Surgical solutions for osteoarthritis (OA) or rheumatoid arthritis (RA) in the ankle are less clear-cut than those for hip or knee arthritis. Repair methods available to you include arthroscopy, fusion (arthrodesis), joint replacement and distraction arthroplasty.  

In this minimally invasive surgery, a lighted scope and narrow instruments are inserted through small incisions in the ankles. Surgeons remove pieces of cartilage or bone debris from the joint space. It is most effective when pain is due to contact between bone spurs and the arthritis has not yet caused significant cartilage damage. Arthroscopy can make an arthritic joint deteriorate more rapidly. 

In fusions, surgeons remove the surfaces of the bones affected by arthritis and join the them with plates and screws until they grow together, or fuse. Pain relief can be dramatic, but it comes at a price: loss of up-and-down and side-to-side movement. Lost mobility can lead to an abnormal gait, potential arthritis in nearby joints and an ankle that can’t flex enough for sports or climbing stairs. If one ankle is fused, it is important that the opposite ankle still has good mobility. 

Ankle replacement is more complicated than fusion and requires a high degree of surgical skill. Replacing a damaged ankle may be an option for people with advanced arthritis that has destroyed ankle joint surfaces and interferes with daily activities. Although implants continue to improve, they are not generally the best choice for younger, more-active patients.  

During ankle replacement, the surgeon makes an incision in the front of the ankle, removes the damaged bone and cartilage, reshapes the surfaces and attaches the artificial joint components with a special glue. Bone grafts and screws  support and stabilize the ankle. 

Ankle replacement relieves pain and preserves more mobility than fusion, but not the full range of motion you once had. Being able to move the new joint means that less stress is transferred to nearby joints. This reduces the chance of developing arthritis in those joints. 

This procedure uses the body's natural repair mechanisms to help the joint heal itself. It involves pulling the joint surfaces slightly apart and holding the bones in place with pins set in an frame on the outside of your ankle. The surgeon drills small holes in the bone to help stimulate cartilage repair. Stem cells from your bone marrow (collected from your pelvis with a needle) are used to jumpstart the repair process.  

You wear the frame for about three months before switching to a temporary walking boot. Full recovery takes close to a year. It is not an option for people who have no ankle motion or advanced inflammatory arthritis. Unlike ankle replacement or ankle fusion, ankle distraction arthroplasty preserves the joint and its natural motion.