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There are several options for treatment of arthritis of the ankle. This article outlines the pros and cons of two types of surgeries that a patient can undergo: joint fusion and joint replacement.

Arthritis, a condition characterized by joint inflammation, is a common disease that affects a significantly proportion of the population. While there is no cure for the disease, there are several treatments that can help ease symptoms, reduce pain and improve joint motion. Arthritis can affect several regions of the body, including the knees, hips and ankles.

One of the surgical treatments for patients with arthritis of the ankle is known as ankle fusion or arthrodesis. In fact, ankle fusion is the gold standard surgical treatment for patients that experience ankle joint pain. During an ankle fusion, surgeons will use different components, including pins, screws, plates and bone grafts, to join the shinbone to the bone in the lower part of the ankle joint. Another type of surgery that patients with arthritis of the ankle can undergo is replacement of the ankle joint. As medical device companies continue to manufacture better models of artificial ankle joints, joint replacement surgeries are becoming increasingly popular.

If you have arthritis of the ankle and your physician suggests that you undergo surgery, then your two options may be either ankle fusion or ankle replacement. So which one is best? This depends on the individual. Experts in the field of orthopedic surgery still debate whether ankle fusion or ankle replacement is better for patients. Unfortunately, results from clinical studies can vary since the exact manner in which surgeons actually do ankle fusion and ankle replacement and the type of components they use vary between surgeons and institutions.

One meta-analysis looked at data from 49 different studies that involved more than 2,100 patients. They found that more than 66 percent of all patients who underwent either type of surgery have either good or excellent results. These are the pros of cons of each surgery.

Ankle fusion

Pros

Ankle fusion significantly helps reduce joint pain. In an ankle fusion, the pain is eliminated by stopping the grinding that is caused when one bone touches another due to a loss of a cushioning surface called cartilage. Another major advantage of ankle fusion is that it generally lasts a lifetime.

Cons

One of the cons with an ankle fusion is that patients will experience some lack of mobility. This is because it stiffens one bad joint (which is already very stiff). However, it leaves the rest of the joints that surround the stiff joint very flexible, which allows for mobility. Therefore, ankle fusions may not be ideal for patients who lead an active lifestyle as it restricts the types of activities they can do. Furthermore, ankle fusion can change the mechanics of a foot, which increases the risk of arthritis in the nearby joints.

Ankle replacement

Pros

The American College of Foot and Ankle Surgeons have given these new joint replacement devices a vote of confidence and have stated that the safety of these are comparable to the safety of undergoing an ankle fusion. Compared to ankle fusions, patients who undergo ankle replacement tend to be able to lead more active lives. There are several different types of artificial ankles on the market, and many of them have been shown to provide more functional results than ankle fusions.

Cons

There are some studies that suggest that ankle replacements wear out quickly, causing patients to undergo a more complicated and riskier second surgery after just a few years. Furthermore, success rates are found to be lower than in patients that undergo knee and hip replacements. This is largely due to the challenges that patients experience due to the unique physiology of the ankle.

Another major con of ankle replacement surgery is that many people are not good candidates for the surgery. People who are young and active are not considered good candidates for ankle replacements and are generally counseled against it. This is because high levels of activity tend to wear out the artificial joints more quickly. Furthermore, overweight or obese people are also not good candidates for the surgery as carrying extra weight puts more stress on the artificial joint and can lead to early failure of the replacement joint.

One of the most important cons when it comes to the ankle replacement surgery is the durability of the replacement. One study conducted in 2010 in Finland showed that almost one in five replacements failed within five years of the surgery. This was generally due to some of the components becoming unstable or loose. While the newer devices on the market seems to promise better durability, at this point, it is too soon and too early to tell. There need to be more long term studies to evaluate whether they truly do last a longer time.

Conclusion

The choice to undergo either an ankle fusion or ankle replacement depends on the individual as well as the patient. There are several things that need to be taken into consideration including characteristics of the patient (weight, severity of disease, activity level, affordability of artificial replacements, etc…) as well as the skill of the surgeon. It is best to consult with your surgeon to come up with a solution that is best suited for you and your lifestyle.

  • Adams, J. Crawford. "Arthrodesis of the ankle joint." The Journal of bone and joint surgery. British volume 30.3 (1948): 506-511.
  • Ahlberg, Åke, and Anders S. Henricson. "Late results of ankle fusion." Acta Orthopaedica Scandinavica 52.1 (1981): 103-105.
  • Jensen, Niels Chr, and Karsten Krøner. "Total ankle joint replacement: a clinical follow up." Orthopedics 15.2 (1992): 236-239.
  • Photo courtesy of SteadyHealth

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