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Garden State Orthopaedic Associates, P.A.
28-04 Broadway, Fair Lawn, NJ 07410
Phone:201-791-4434 | Fax:201-791-9377




Arthroscopy, Ankle Fusion, or Total Ankle Replacement. How to Decide?

Kenneth A. Levitsky, M.D.
Garden State Orthopedic Associates

Although not as common as arthritis of the hip or knee, arthritis of the ankle is a painful condition manifest by swelling, stiffness, a limp, and loss of function.  By definition, ankle arthritis is the loss of the normal joint cartilage of the ankle joint.  This can occur from many conditions such as injury or fracture, rheumatoid arthritis, or osteoarthritis.

The non surgical treatment of arthritis of the ankle includes non steroidal anti-inflammatory medications, physical therapy, bracing, and injection therapy.

The surgical options for treatment include surgical “clean out” procedures (either performed arthroscopically or by standard incision), ankle fusion surgery, or total ankle replacement.

As with all medical procedures, each of the above surgical options has it’s pros and cons.  The “clean out” procedure is the least invasive or the three choices above, but its success is limited and restricted to those ankles with mild and specific types of arthritis patterns.

For years, the “gold standard” operation for severe arthritis of the ankle that was resistant to nonsurgical treatment was considered to be an ankle fusion.  This procedure removes the arthritic cartilage from the ankle joints and fuses the bones of the ankle together with metal screws, plates, or a combination of both so that the ankle bones grow together as one.  This essentially eliminates the arthritic ankle joint, thus eliminating the pain from arthritis.  This operation has and continues to be a reliable method for treatment.  The disadvantages of this procedure include loss of normal ankle motion and the possibility of developing arthritis in other nearby foot joints that are called upon to ‘perform extra duty’.  Irrespective of these considerations, ankle fusion continues to be a reliable and effective treatment for disabling ankle arthritis that has stood the test of time.

Ankle

More recently, there has been renewed interest in Total Ankle Replacement.  The early results from ankle replacement surgery in the 1970’s and 1980’s were disappointing and the procedure was essentially abandoned.  However, recent advances in design, technology, and surgical technique have resulted in new interest and improved results with this surgical procedure.  There are currently five FDA approved total ankle replacement designs available for implantation.

Although the long-term results of the procedure are yet unknown, the short-term results are encouraging.  Recent research has concluded that relief of pain and walking ability is not significantly different when ankle fusion is compared to total ankle replacement surgery, however those patients with successful ankle replacements did demonstrate improved function.

Although the early results are quite promising and this exciting procedure can be a very good choice for some, as noted above, we still are awaiting the long-term results.

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