Fortunately, ankle arthritis is less common than arthritis of the hip or knee. But when it hits, the problem can be life changing. If the pain and limitations are severe enough, surgery may be in order. With technical advances over the past 10 years, many patients come to the office with questions about which brand of ankle replacement is the best one for them. That's certainly a valid question, and one that is very interesting to ankle orthopaedists. But the discussion about ankle arthritis begins not with which brand of ankle replacement, but which surgery is the right one for me.
Although one can make comparisons between arthritis of the ankle and knee, the ankle is very different in many ways. Unlike the knee, the ankle has neighboring joints in the hindfoot below the ankle, which help out with motion. The oldest surgery for an arthritic joint is a fusion, where bone heals across the joint. A fusion in the hip or knee is not fantastic; there will be much stiffness. But a fusion of the ankle can do very well, since those hindfoot joints keep things moving. The average ankle fusion still has some motion, and many patients with ankle fusions walk with no limp at all. In many cases, an ankle fusion can work just as well as an ankle replacement.
As in any joint replacement, an ankle replacement has metal components that replace the arthritic ends of the bones (tibia and talus), along with a plastic liner in between, to make friction-free gliding. Both ankle fusions and ankle replacements offer tremendous pain relief for patients with arthritis. The ankle replacement offers improvement in motion as well. In the past, ankle replacements tended to not last long enough, but improvements in surgery and technology have made things better.
There are different brands of ankle replacements, and most are more similar than different. Some are inserted from the front, and others from the side. Dr. Greisberg has performed hundreds of ankle replacements over the past 19 years. He is also experienced in revision surgery, and conversion of ankle fusions to ankle replacement. Here is an article he authored about the experience of his mentor, Dr. Hansen, in Seattle.
Greisberg J1, Assal M, Flueckiger G, Hansen ST Jr.
Takedown of ankle fusion and conversion to total ankle replacement.