ANKLE ARTHRITIS: Overview
Dr Sheskier is a member of the Arthritis Foundatiion
Ankle arthritis can be due to many causes: Birth defects, infection, ankle sprains, inflamatory arthritis, avascular necrosis, aging and most commonly due to trauma/ ankle fractures. Regardless, the end result is loss of articular cartilage and ankle pain with stiffness, swelling and loss of function.The initial treatment relies on weight loss,arthritis medications, use of walking aids (canes, braces,shoe modifications) and physical therapy. Injections can be helpful e.g. steroids can give temporary relief. I have been using Injections with Hyaluronic acid (Synvisc) as well as other types with positive results helping patients to avoid or postpone surgery.
1.Ankle Arthroscopy can be used removal of bone spurs, scar tissue impingement and loose bodies often associated with arthritis. Via small incisions a camera is inserted to view and repair the cartilage of the ankle. Drilling and micro fracture can be used to cause the body to grow new cartilage for small isolated areas of cartilage loss. Osteochondral grafting from the knee or a fresh frozen allograft of bone and cartilage for "discrete" lesions of the talus. Recently the addition of stemcells has enhanced the surgical outcome.
2. Distraction arthroplasty. This is done by the placement of an external fixator (erector set) where the joint distracted or pulled apart. Allowing the cartilage in some cases to reconstitute itself. It also requires arthroscopic cleanout. THe distractor is worn for 2-3 months.
3. Ankle Fusion The Gold standard, until recently, has been ankle fusion which has a 95% fusion rate but a 100% loss of any remaining motion and the possibility of other joints in the foot becoming symptomatically arthritic by 10 years postoperatively. In patients with stiff ankles or a history of infection this is still the top choice.
4.Total Ankle Replacement. Our ability to perform a long lasting total ankle replacement has greatly improved. I have been performing ankle replacements for over 15 yearswith the success rate comparable to that reported in the literature.I am well versed and experienced in revision ankle replacement surgery as well as post replacement fusions. I have been trained in performing total ankle replacements for the following total ankle replacements: