- Researchers say replacement surgery as well as fusion surgery can help people with ankle osteoarthritis.
- They note that there are potential complications from both procedures.
- Experts say milder forms of ankle osteoarthritis can be treated with steroid injections and topical creams.
- They say you reduce your risk of osteoarthritis by staying active and wearing supportive shoes.
Total ankle replacement and ankle fusion both improve a person’s quality of life and have similar clinical scores and risks after surgery.
That’s according to a new study published in the Annals of Internal Medicine.
Researchers at the University College London and Imperial College London completed a randomized controlled trial of 303 people with end-stage ankle osteoarthritis to determine if an ankle replacement or ankle fusion were superior in providing relief and improving quality of life.
All participants were between 50 and 85, and their treating surgeon believed they were suitable for either surgery.
The scientists followed the participants for 52 weeks after surgery. They calculated each person’s clinical response using the walking/standing domain of the Manchester-Oxford Foot Questionnaire both before surgery and 52 weeks after. A total of 281 scores were analyzed.
The participants’ scores were similar for both treatments. However, in a retrospective analysis, the researchers found that ankle replacement using a fixed-bearing implant had better outcomes than ankle fusion at 52 weeks.
Both groups had similar rates of adverse events.
For those who received ankle replacement, wound-healing complications and nerve injuries were most common. Those who received ankle fusion reported more problems with blood clots and nonunion of the ankle bones.
“This is an important study,” said Dr. David Lee, an orthopedic foot and ankle surgeon and chair of the orthopedics department at MemorialCare Long Beach Medical Center in California. “There are many challenges to conducting a randomized controlled trial for surgical treatment, and the authors are to be commended.”
“As mentioned in the paper and editorial, many of the findings are consistent with existing non-randomized trials that have been published,” Lee told Healthline. “One interpretation of these findings could be that there is a role for both ankle replacements and ankle fusions as surgical treatment options. Hopefully, future findings will provide even more specific data to guide nuanced decision-making.”
During an ankle replacement, the physician removes damaged cartilage and bone and replaces them with metal or plastic parts.
An ankle fusion is when the ankle points are fused to the leg bones to prevent motion and decrease pain.
There are numerous factors when deciding between ankle replacement and ankle fusion.
“Typically, fusion is undergone on younger patients, as the lifespan for an ankle replacement is about 15 years, and the replacement is not meant for any high-impact activities,” said Dr. Omar Yaldo, an orthopedic surgeon at the Hoag Orthopedic Institute in Southern California.
“Other considerations include deformity of the ankle joint as this may favor the choice of fusion,” Yaldo told Healthline. “Historically, very stiff ankles with significant loss of range of motion was a consideration for fusion as most patients do not gain any motion from ankle replacement. However,
“Overall, both are excellent options,” he added. “Shared decision-making between you and your surgeon can help determine which is optimal for your specific pattern of arthritis and your specific needs as a patient.”
“But, it is unusual that there wouldn’t be a clear cause of arthritis in the ankle, such as a traumatic injury,” said Dr. John G. Kennedy, the chief of NYU Langone Orthopedics’ Division of Foot and Ankle Surgery in New York. “Rheumatoid conditions may lead to ankle arthritis, but the vast majority are from injuries, such as ankle sprains and fractures.”
Ankle osteoarthritis can cause severe pain and disability.
“It can take months or even years after the initial trauma for someone to reach end-stage ankle arthritis,” Kennedy told Healthline.
Symptoms include pain, swelling, and loss of function.
People with ankle arthritis may experience the following:
- Pain and stiffness, especially in the morning or after sitting for extended periods
- Tenderness when touching the joint
- Swelling around the ankle
- Decreased range of motion preventing you from bending or flexing your ankle completely
- Difficulty walking due to pain
“When discussing treatment options, we are mostly concerned with their pain,” Lee said. “Especially if it is affected their function. Pain is what we, as orthopedic surgeons, are looking to improve, if not eradicate, whether through surgical or non-surgical treatments.”
Many people use over-the-counter pain relievers or topical creams to lessen the pain in the early stages. Exercise can help and a physical therapist can help you find the most beneficial activities.
Some people find that steroid injections help ease the pain, but this is temporary. It could be necessary to have the injections three or four times per year.
There isn’t a cure for arthritis.
However, there are some steps you can take to preserve your joints for as long as possible. Yaldo offers the following suggestions:
- Maintain your motion by doing range-of-motion and stretching exercises daily.
- Wear stiff, supportive, and well-cushioned shoes.
- Find activities that keep you stay active without aggravating or exacerbating your ankle arthritis, such as biking or swimming.
- Maintain a healthy body weight, as a higher body weight places significantly more force on the ankle.
- Wear an appropriate brace and rocker-bottom shoes during high-impact activities, when walking on an uneven surface, or walking for long distances.
“There are no scientifically-based shortcuts I am aware of, no ‘best’ show or secret supplement,” Lee said. “General principles include maintaining strength and mobility in the foot and ankle, all the way up to your core through lower-impact exercise.”