Evolution of Technology

Ankle Replacement

Ankle arthritis treamtent has made incredible imrpovements in tehncology, techniquem and success recently. Treatment options include debridement, osteotomies or cutting of bone, arthrodesis or fusion of the ankle joint, and more importnantly ankle replecment. Ankle replacement is typically performed through a single incision over the front of the ankle. After safely dissecting down to the ankle joint, attention is first turned to shaping the tibia with a bone cut. This can be performed either by alignment rods with guides at the time of surgery or by custom 3D printed guides based off of a pre-operative CT scan.

The top of the talus, or the mortise of the ankle joint, is typically shaped next through similar means. After both the tibial and talar joint surfaces have been removed and shaped the implants are sized and the bone is prepared for insertion of components. Most ankle replacement components are “press fit” which means they are inserted without any bone cement. These implants are specially designed to have a layer of metal that is porous or very rough so that bone can grow into the implant. Between the metal parts is a specialized piece of plastic to allow for movement and gliding, similar to a healthy ankle joint. The tibial component is usually made of a metal tray, often titanium, with a polymer piece fit to the tray. This acts as the new tibia joint surface. The talar component is usually made of a smooth, highly polished piece of metal which acts as the new talar joint surface. Patients are allowed to put weight on their joint replacement right after surgery and are usually enrolled in physical therapy to ensure that they maintain ankle motion.

Evolution of Procedure

Ankle Replacement

Treatment will typically start without surgery and includes NSAIDs, rest, activity modification, and bracing. As symptoms progress, however, surgical intervention may be able to improve patients’ pain.

As above, there are several broad categories of treatment for ankle arthritis: temporizing or debridement, fusion, and replacement. The “temporizing” surgeries seek to provide more temporary relief of pain, but are less invasive. One such option is the ankle scope (or ankle arthroscopy) in which a small camera and tools are inserted into the ankle joint via small surgical cuts in order to remove loose or damaged cartilage pieces and scar tissue.

Another option often reserved for young post traumatic arthritis patients is the distraction arthroplasty. This procedure involves forcefully pulling the tibia and talus apart (or distracting them) for a prolonged period of time to allow scar tissue to form in this space. This new scar tissue acts as a temporary buffer between the tibia and talus so that the two bones no longer rub on one another, thereby lessening pain and improving range of motion.

Another category of treatment are fusion procedures. Fusion aims to alleviate pain by stopping motion through the ankle joint. While fusion procedures are reliable in terms of pain control, and can be performed through smaller incisions, patients can no longer move their ankle after the fusion procedure is complete.

The third broad category of treatment is ankle replacement, otherwise known as total ankle arthroplasty. Ankle replacement involves removing the joint surface of both the talus and tibia and inserting implants made from metal and plastic. Ankle replacement is typically performed through a larger skin incision over the front of the ankle. The benefit of this procedure is relief of pain by removing the bad joint surface, while maintaining motion through the joint and improving function.

Evolution of Diagnosis

Ankle Arthritis

Ankle arthritis, also called osteoarthritis of the ankle, refers to a degenerative condition of the ankle joint in which there is progressive loss of cartilage between the talus and tibia bones (or the tibiotalar joint). As cartilage is lost and there is progressively more contact between the bones in the ankle patients will begin to develop pain in their ankle as well as severe loss of range of motion.

Arthritis of the ankle is typically caused by a traumatic injury such as an ankle fracture or dislocation greater than 60% of the time . Less commonly patients develop arthritis due to a deformity in their ankle joint or from overload from excessive activity or obesity. This is referred to as primary osteoarthritis, and other reasons include a history of septic arthritis, gout, neuropathy and autoimmune arthropathies.

Patients with ankle arthritis typically report severe pain in their ankle joint after activity or prolonged periods of standing. Xrays and imaging of the ankle joint will show loss of the space between the tibia and talus, centrally or on the medial or lateral joint, indicating that the cartilage in that space has been lost.