Greater San Francisco Bay Area Orthopedists Treating Ankle Arthritis

Arthritis in the ankle joint can destroy or damage cartilage creating severe pain that affects one’s lifestyle. If bracing and anti-inflammatory injections don’t bring relief, the two surgical treatment options are to either fuse the ankle or replace it with an artificial joint.

Ankle fusion has been the standard of care for ankle arthritis, but improved technology has increased the usage of ankle replacement surgery. Some people are good candidates for fusion and others for ankle replacement. Many may have the option for either.

Both surgeries may be done on an inpatient or outpatient basis. Recovery from an ankle replacement is generally quicker than from ankle fusion.

Potential patients for ankle fusion or ankle replacement first need to decide whether their pain is a big enough problem for them to warrant going through the potential risk from the surgery and the recovery process. They should thoroughly discuss the pros and cons of each procedure with their orthopedic surgeon.

Ankle Fusion

In ankle fusion surgery, an orthopedic surgeon fuses the leg bone to the anklebone using an external or internal fixation procedure:

• External fixation involves surgical pins joining the leg and anklebones with an external rod and pins holding the bones in place until they fuse together.
• Internal fixation generally involves removing the cartilage at the ankle joint and compressing the ankle and leg bones together with plates and screws to fuse them.

Many people have the misconception that ankle fusions don’t turn out well and that ankle fusion patients still have great pain and walk with a limp. That’s not the case. Fusing the ankle is a reliable way to get rid of pain, and many patients can still walk normally without a limp. The ankle will most likely have a reduced range of mobility after ankle fusion.

The drawback to fusion is that the joints in the foot below the ankle have to make up for that loss of ankle motion. Those joints are not designed to work that way and will become arthritic and painful. This is called adjacent segment disease.

Those lower joints may eventually need to be fused as well, and that results in limited function, with very stiff movement and a limp. Everyone with a fused ankle eventually develops adjacent segment disease in the lower joints, generally after 20 years.

Ankle Replacement

By maintaining motion, ankle replacement prevents the fusion problem of adjacent segment disease from occurring. Patients who have had fusion of joints below the ankle are often good candidates for ankle replacement.

In ankle replacement, a prosthetic ankle made of metal and/or plastic replaces damaged ankle and leg bone surfaces. Current generation ankle replacements have been proven to be very successful and have had good long term follow up studies.

Which is Right for Me?

The vast majority of ankle replacement patients report that their pain is completely gone or is much better. Most eligible candidates for ankle replacement are choosing that option due to the proven durability of the operation and the prospect of retaining the range of motion that a prosthetic ankle joint allows. However, the right choice for you will depend on many factors, including the severity of your condition and your personal preferences.