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Patients with arthritis of the ankle can undergo a type of surgery known as ankle distraction arthroplasty. This article outlines the 7 things you should know if you are considering undergoing joint distraction surgery for ankle osteoarthritis.

Some patients with arthritis, a type of inflammatory joint disorder, are candidates for surgical treatment. There are several different types depending on the type of arthritis, the severity of their symptoms and the type of joint involved.

One of the surgeries that patients with arthritis can undergo is ankle distraction arthroplasty, which is an innovative procedure that helps treat patients with ankle arthritis. Other types of surgeries that patients with arthritis of the ankle can undergo include ankle fusion and ankle replacement. Unlike these two surgeries, ankle distraction arthroplasty focuses on joint restoration.

These are the seven things you should know about ankle distraction arthroplasty if you have ankle osteoarthritis.

1. Ankle distraction arthroplasty is different from ankle fusion and ankle replacement

While ankle fusion and ankle replacement can be the appropriate treatment method for several cases, these surgeries tend to reduce the functioning of the ankle joint as a means to reduce arthritis-related pain. In the case of ankle distraction arthroplasty, surgeons mechanically unload the arthritic joint to reverse the arthritis and reduce pain without actually affecting the functioning of the ankle joint. In this manner, ankle distraction arthroplasty helps preserve the range of motion of the ankle.

2. Ankle distraction arthroplasty works by pulling joint surfaces apart

Arthritis develops when patients start to lose their articular cartilage, which is a smooth surface that covers the end of the bones. This reduction in cartilages leads to joint pain and stiffness, which can severely decrease a patient’s quality of life. While it isn't yet clear how exactly distraction helps improve arthritis, it is known that distraction arthroplasty works by restoring lost cartilage through the body’s natural repair mechanisms.

"Distraction" literally means pulling the joint surfaces apart through the use of a method known as external fixation, which causes the dense bones below the cartilage to soften, develop blood vessels, and produce a healing response. In fact, imaging studies have shown that there is often a dramatic regenerative tissue growth on the arthritic bone surfaces one year after the surgery.

3. Ankle distraction arthroplasty involves the use of a frame

In order to carry out the surgery, the surgeon will apply a frame to the ankle while the patient is under anesthesia. The surgeon will attach rings to the skin of the lower leg through pins and wires. Then, the surgeon will achieve distraction of the joint by pulling the rings and then locking them. Furthermore, the frame has hinges that allow the ankle to have significant mobility.

4. Other procedures are combined with ankle distraction arthroplasty

In order to maximize the best possible outcome, doctors will combine the surgery with cartilage stimulating procedures which ensure that the patient will have increased levels of cartilage. One technique to encourage cartilage growth is known as the microfracture technique, which helps improve cartilage formation. Another technique for similar results is known as neo-cartilage (“new” cartilage) tissue formation, which involves taking mesenchymal stem cells from the patient’s pelvis with a needle and transforming them into cartilage forming cells. Finally, many patients will have bone spurs in their ankle joints at the time of surgery which will be removed. An optimal combination of these techniques can help the patient achieve the best possible outcome.

5. What happens after the surgery?

After the patient has been discharged from the hospital after the surgery (usually two days), they are then encouraged to start walking with the help of a physical therapist. Furthermore, patients will have ongoing physical therapy and can be prescribed oral pain medication as long as they need it. Additionally, doctors and physical therapists encourage weight bearing on the leg that was operated on. Patients can also take daily showers and are allowed to swim in a chlorinated pool.

The range of motion exercises (which are taught by the physical therapist) will continue until the frame has been taken off, generally after 10 weeks. The frame removal is also conducted in an operating room while the patient is sedated. After this procedure, you will be able to go back home right away and will not require hospitalization. In order to help patients become more comfortable, the surgeon will place a walking boot on the patient in the operating room.

6. There are certain risks associated with ankle distraction arthroplasty

As with all surgeries, the risks associated with an ankle distraction arthroplasty include infection. Fortunately, the type of infection that can develop in patients with ankle distraction arthroplasty is superficial and therefore, the risk is minimized as long as the piercings are cleaned every day. Even if you develop an infection, it is usually successfully treated with oral antibiotics.

7. There are several advantages to this an ankle distraction arthroplasty

One of the major advantages associated with this type of surgery is that the patient can still undergo an ankle fusion or joint replacement surgery as the architecture of the bones is still well preserved. Hence, if the ankle distraction arthroplasty does not work, then these other procedures can be done without any significant complications.

  • Paley, Dror, et al. "Distraction arthroplasty of the ankle—how far can you stretch the indications?." Foot and ankle clinics 13.3 (2008): 471-484.
  • Tellisi, Nazzar, et al. "Joint preservation of the osteoarthritic ankle using distraction arthroplasty." Foot & ankle international 30.4 (2009): 318-325.
  • Paley, Dror, and Bradley M. Lamm. "Ankle joint distraction." Foot and ankle clinics 10.4 (2005): 685-698.
  • Photo courtesy of SteadyHealth

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