Ankle arthritis is a disabling condition that can have a significant impact on quality of life. Most cases are linked to some kind of trauma, such as a fracture or severe sprain which can hasten the wear and tear of joint cartilage that occurs naturally as we age.
Osteoarthritis of the ankle
Osteoarthritis – also known as wear and tear arthritis – occurs most commonly in weight-bearing joints like knees and hips but it can also affect the ankles. It is a chronic condition resulting from the breakdown of cartilage in the joints which normally cushions the ends of the bones. Cartilage loss causes the bones to start rubbing together, resulting in pain, stiffness and loss of movement.
Other types of arthritis may also affect the ankle joint, including rheumatoid arthritis which is an autoimmune condition caused by the body’s own immune system mistakenly attacking the joints. In around 90% of people who have rheumatoid arthritis, the ankles and feet are affected. Gout, which is caused by excess uric acid in the bloodstream, attacks the big toe first but may also affect the ankles in future attacks.
Lifestyle changes for ankle arthritis
Every year in the UK around 29,000 people are referred to an orthopaedic specialist for foot and ankle problems. Around 3,000 of them receive surgery. For the remainder, lifestyle changes such as weight loss and low impact exercise, coupled with painkillers, physiotherapy and supportive ankle braces may provide sufficient relief from symptoms, at least in the early stages of the disease.
There are two main types of surgery for ankle arthritis – ankle arthrodesis (or ankle fusion) and ankle joint replacement. Both offer excellent results and can vastly improve quality of life, allowing people to resume the activities they love and be able to walk and climb stairs without a problem again.
The long-term survivorship of the newer generation of ankle replacements is still unknown and around 10% of people have some unexplained pain even after surgery. In ankle arthrodesis, over time the stresses may cause the adjoining joints to wear. Both types of surgery are routinely performed to treat ankle arthritis but we don’t yet fully understand which offers the best long-term outcomes for patients.
A randomised clinical trial – the TARVA trial – has recently begun in England to try and answer this question. It is comparing the two procedures in patients with end-stage ankle arthritis to ascertain which produces the best outcomes. The trial will involve around 330,000 patients aged from 50 to 85.
Here at Castle Orthopaedics we are very interested in the findings of this trial. One of our consultants, Martin Raglan is actively involved as a Principal Investigator on the trial. He is also involved in the post-market surveillance multi centre trial of the Infinity Total Ankle Replacement, which has been shortlisted for the prestigious Roger Mann prize in the USA.
We also run a national ankle course for national and international foot and ankle consultants, every two years, with the aim of enhancing outcomes in ankle arthritis.
Ankle arthrodesis involves removing the surfaces of the arthritic joint and using screws or plates to hold the surfaces together and prevent any movement. In time the two bones fuse together. The procedure may be performed as keyhole or traditional open surgery.
Ankle joint replacement
Ankle joint replacement involves removing the arthritic joint and replacing it with an artificial joint made of metal and plastic and ensuring the joint is balanced. You will be encouraged to get up and about as quickly as possible with painkilling medication to keep you comfortable. The aim will be to start early mobility of the ankle joint.
Whichever type of surgery you have you may need to wear a boot or plaster to keep the ankle protected for between six to 12 weeks and may need to use crutches or a frame for the first few weeks to help you move about. When lying down keep your leg raised above the level of your heart, using pillows or cushions, as this reduces swelling and helps the wounds heal. Immediately after surgery you will need to keep the wound clean and dry. You won’t be able to drive until you can press down on the pedals without pain and you can normally resume work around four to six weeks after surgery. People heal at different rates so your surgeon will discuss your particular circumstances with you. You will have a follow-up appointment approximately two weeks after surgery.
If you are experiencing ankle pain or if you have a diagnosis of ankle arthritis and are considering whether to have ankle arthrodesis or ankle replacement surgery, contact us to discuss the options.
Here to help
Following the lockdown, Castle Orthopaedics is now re-open for virtual and face to face appointments at both Spire Nottingham Hospital and BMI The Park Hospital. Surgery is now also being scheduled once again, which means that injuries requiring surgery can be treated.
Our orthopaedic consultants each specialise in a particular area of orthopaedics, giving you added peace of mind that you are receiving expert medical advice and highly tailored treatment.
BMI The Park Hospital
Sherwood Lodge Drive Burntstump Country Park, Arnold NG5 8RX
Spire Nottingham Hospital
Tollerton Ln, Tollerton, Nottingham NG12 4GA