STORY BYANKLE ARTHRITIS
Time heals all wounds…for awhile,
anyway.
Athletes who were sidelined years before from a nasty ankle injury sometimes find themselves limping from new pain.
Though ankle arthritis is far less common than that of other joints, it certainly can be equally debilitating and often requires treatment by an orthopedist.
Osteoarthritis generally only settles in the ankle years after significant injury to the joint. Otherwise, rheumatoid arthritis may be a cause. In either case, the effect on the joint is quite similar.
There is often a narrowing of the ankle joint space between the tibia (lower leg bone) and the talus (ankle bone), with varying degrees of damaged cartilage. Bony outgrowths known as osteophytes may also be present in and around the joint space.
In addition to chronic or intermittent pain, patients may notice that the ankle is swollen and warm to the touch. They may feel grinding or popping in the ankle, and the ankle may be particularly stiff in the morning or at the beginning of activity.
Fortunately, there are a variety of treatment options that range from the very minimally invasive to complete replacement of the joint.
Thomas Clanton, M.D., professor in the Department of Othorpedic Surgery at The University of Texas Medical School at Houston and co-medical director of the Roger Clemens Institute for Sports Medicine & Human Performance says, “Physicians have searched for optimal treatment strategies that can be used as a continuum of care for patients with severe ankle arthritis. However, when non-operative solutions fail, surgery may be necessary.”
The many surgical options for patients with ankle arthritis include:
Arthroscopic debridement only requires
the surgeon to make three small incisions around the joint to insert
a camera and necessary surgical instruments. Any arthritic spurs
or loose bodies can be removed and irregularities in remaining
cartilage may be shaved.
Joint distraction is a rather new, but promising
technique which is based on evidence that if the joint is “distracted” or
unloaded for a period of time, remaining cartilage may naturally
regenerate and the joint space will expand.
Though the patient must wear an external fixed frame
for up to three months, no bone in the ankle is removed or permanently
surgically altered. About 50 patients in the Netherlands were followed
for up to seven years after the procedure and three-fourths report
Total replacement of the ankle joint is also
a relatively new science when compared to hip and knee replacement.
The first generation of ankle replacements consisted of two component
designs: one metal component was cemented into the tibia, the
other in the talus.
Now, three components are used: one metal component is fixed to the tibia, the other is fixed to the talus, and the third, a polyethelene bearing, that floats between the other two. This type of ankle replacement was also originally cemented in place, but now almost all ankle devices have beaded surfaces which are coated with a natural compound that encourages bony ingrowth.
Perhaps the most resisted solution for patients, but considered the “gold standard” treatment for severe ankle arthritis, is ankle fusion. This surgical technique involves removing bone from the tibia and talus and binding them together with a plate or large screws.
Eventually, the surgically treated ends of the bones grow or fuse together. Though this stabilizes the ankle, it allows no motion at the ankle joint. But problems can set in later. William McGarvey, MD, assistant professor of orthopaedics at UT-Houston Medical School explains, “Though the ankle joint motion is eliminated, adjacent joints compensate and may allow 50 percent of this motion to return. As a result, long term degenerative arthritis may over take these adjacent joints.”
Particularly in younger patients, preservation of motion, while relieving pain, is the primary goal. Every effort is made to avoid fusion, but even in the most skilled hands and the best of circumstances, this is not always possible. In such circumstances, fusion may prove the only viable option, allowing the younger ankle arthritis patient to return to work and participate in some mild athletic activities.
UPDATED: 5-15-2003
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Dr. Thomas Clanton is a professor in the Department of Othorpedic Surgery at the UT Medical School and co-medical director of the Roger Clemens Institute for Sports Medicine & Human Performance.
See Dr. Clanton also at:
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