Ankle Arthritis and Realignment Osteotomy

Ankle arthritis is common and as debilitating as knee arthritis or hip arthritis. Ankle arthritis, unlike knee or hip arthritis, is usually post-traumatic. While almost all arthritis of the knee and hip is age-related and genetic in nature, up to 80% of ankle arthritis is post-traumatic. Usually, the patient had a fracture or very significant ligamentous injuries at some point. It may take 20 to 30 years for such arthritis to become problematic in the ankle.

Ankle arthritis does not automatically mean that a fusion is necessary as the treatment. Although for many years fusion surgery was the so-called ‘gold standard’ for the treatment of painful arthritis, this is no longer true. There are a variety of treatment options that should be discussed at your clinic visit. However, unless your surgeon is current and is performing cutting-edge surgeries, he or she may not think outside of fusion for the treatment of ankle arthritis.

Ankle arthritis does not automatically mean that a fusion is necessary as the treatment. Although for many years fusion surgery was the so-called ‘gold standard’ for the treatment of painful arthritis, this is no longer true. There are a variety of treatment options that should be discussed at your clinic visit. However, unless your surgeon is current and is performing cutting-edge surgeries, he or she may not think outside of fusion for the treatment of ankle arthritis.

 

If a patient presents with arthritis and a deformity whereby the ankle turns either in or out too much, a realignment osteotomy is a good option. This surgery is very technical and requires good technique, proper patient selection, and thorough preoperative planning. IF your surgeon is able and willing to do this type of surgery, it is a great way to keep your own ankle joint and reduce pain yet increase function. Eventually, as one ages a fusion may be necessary; however, a well-done realignment osteotomy is often converted to a total ankle replacement. A replacement can treat end-stage arthritis with a motion preserving implant.

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The basic principle of a realignment osteotomy is change in the contact pressures of the ankle joint.

An ankle joint that is misaligned by even 2mm (2 millimeters) can have increased contact pressures of up to 42% overall. More contact pressure eventually leads to cartilage damage and possibly pain. Unless the ankle is as close to anatomically aligned as possible, the arthritis will progress and the pain will remain. By changing the overall shape of the ankle, pressure is redistributed and the cartilage is preserved. Patients that undergo this surgery have pain relief and improved function. This is so even when up to 50% of the joint surface is arthritic prior to surgery.

How do you know if your ankle would benefit from a realignment osteotomy?

The first thing you must do is find a surgeon that performs these surgeries, understands them and is willing to do them. Many surgeons still believe that fusions are the only answer to arthritis. If your surgeon tells you that fusion is the only option and that nothing else will ever work, simply locate a surgeon that is performing these advanced joint-preserving procedures. If you have arthritis in the ankle with a deformity, you could benefit from this procedure. The usual deformities are a ‘valgus’ or ‘varus’ ankle; these are ankles that tilt too much to either side.  (figure 1 )  The individuals that typically do not do well with this procedure have absolutely no cartilage left, infection, neuropathic bone changes (different from sensory neuropathy) or have a totally un-fixable instability of the ligaments. Otherwise, you could be a candidate for this joint-sparing procedure.

If you wish to see if Dr. Warner believes that you are a possible surgical candidate, please answer these clinical questions and upload your films. She will evaluate your case and determine if a consultation for surgery is worth your time.

  • Do you have arthritis of the ankle?
  • Is your ankle arthritis due to a previous fracture?
  • Is your ankle arthritis due to infection or neuropathy?
  • Is your ankle arthritis from a severe ankle sprain or a series of minor ankle sprains?
  • How old are you?
  • What is your height?
  • What is your weight?
  • Do you have an osteochondral defect of the talar dome?  (an OCD?)
  • Have you been told that you have a cartilage fracture?
  • Have you been told that you have dead bone?
  • Have you been told that your only option is a fusion surgery?

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