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Ankle arthritis is a common condition characterised by the inflammation and stiffness of one or both ankle joints. It often develops gradually and can result in pain and limited mobility, affecting everyday activities such as walking, standing, or climbing stairs. There are over one hundred different forms of arthritis, with Osteoarthritis and Rheumatoid Arthritis being the most common. While there isn’t a definitive cure for this condition, there are treatment options available to help alleviate its inflammation and enable an active lifestyle.
Symptoms of arthritis vary depending on the affected joint, often leading to pain and inflammation. Typically, discomfort develops gradually, although occasional sudden episodes can occur. Additionally, individuals with arthritis may encounter the following issues:
The ankle joint, composed of multiple bones, cartilage, and ligaments, is essential for motion and balance.
Many of these joints have a protective covering called the articular cartilage, which promotes smooth and frictionless bone movement during motion. The synovium, a thin membrane encasing your joints, produces a lubricating fluid that minimises friction and allows the cartilage to fulfil its purpose effectively.
Ligaments are strong connective tissues that hold bones together, ensuring joint alignment. Muscles and tendons work together to enhance joint mobility and provide the necessary strength for optimal function. The two primary forms of arthritis that affect the ankles are osteoarthritis and rheumatoid arthritis.
Osteoarthritis (OA) primarily targets the joints, gradually eroding the cartilage until it becomes frayed and uneven. This process leads to discomfort when bones interact directly and triggers the formation of calcium deposits or bone outgrowths.
Rheumatoid Arthritis (RA), on the other hand, is a chronic autoimmune disorder that affects many parts of the body, causing inflammation, swelling, and stiffness accompanied by pain. As an autoimmune condition, RA prompts the immune system to erroneously attack healthy cells, resulting in damage to cartilage and ligaments. In certain instances, it can even lead to bone softening.
Although a complete cure for arthritis is not currently possible, there are several natural approaches that can be employed to manage the condition and enhance your overall quality of life.
Early treatment for any arthritic condition usually involves nonsurgical approaches. Your doctor may recommend a range of non-invasive treatments that you can begin implementing immediately, aimed at alleviating pain, enhancing mobility, and improving your overall quality of life.
These approaches include:
If your chronic arthritis pain prevents you from living your life and is not relieved with other treatments, your doctor may recommend surgery. You have the option to request a referral to Dr. Munjed Al Muderis and request a consultation through our clinic so we can determine the best approach for your pain.
Like all surgeries, certain risks and side effects are associated with different types of ankle operations. Your surgeon will discuss in detail the specific risks and side effects associated with different types of ankle operations during your appointment. Several common surgical treatments for ankle arthritis are described below.
Ankle Arthroscopy
Arthroscopic surgery can be beneficial for relieving the discomfort caused by the early stages of arthritis. This minimally invasive procedure involves clearing loose cartilage, inflamed synovial tissue, and bone spurs from the affected joint.
Arthroscopy provides doctors with a clear view of the ankle without requiring a large incision through the skin and surrounding soft tissues. It is used both for diagnosis and treatment of a wide range of ankle-related issues.
Your surgeon will insert an arthroscope, a small camera, into your ankle joint. The images displayed on the video monitor enable the surgeon to precisely and accurately manoeuvre miniature surgical instruments. This procedure is most beneficial when arthritis has not progressed enough to cause significant narrowing of the joint space between the bones. The use of tiny, thin surgical instruments means that only small incisions are made. As a result, patients often experience less pain and stiffness, a shorter recovery time, and a quicker return to daily activities.
To learn more about the ankle arthroscopy procedure, as well as what you can expect prior to, during, and after the surgery, please visit our Ankle Arthroscopy page.
Total Ankle Replacement (Arthroplasty)
Total ankle replacement involves surgically replacing your ankle’s worn-out cartilage and bones with new metal and plastic joint implants. This procedure restores ankle function and relieves pain. It is most commonly recommended for patients who have:
Ankle replacement surgery eliminates arthritis-related pain, increases your range of motion, and reduces the risk of arthritis developing in adjacent joints. It provides greater mobility compared to fusion surgery and places less stress on other joints.
Dr. Munjed Al Muderis emphasises a holistic approach to ankle arthritis, treating patients as a whole and taking into account the alignment of the lower limbs, which includes the hips, thigh bone, knees, lower leg, foot, and ankle. This comprehensive approach acknowledges that the development of arthritis due to malalignment and deformity in the lower limbs is not uncommon. Moreover, he recognises that addressing long-term malalignment is crucial, as it can lead to ankle arthritis that necessitates correction to ensure the success of ankle replacement.
Ankle implants may require revision over the years, similar to other joint replacements. If the implant fails and the joint requires replacement, a new implant can be fitted in a process known as revision surgery. Implants performed in well-aligned limbs generally have a longer life expectancy.
The use of computerised technology, 3D modelling of lower limb alignment, and collaboration with biomedical engineering have significantly improved the predictability of surgical outcomes for ankle replacement. These technologies and techniques, including patient-specific guides and computerised assistive technology, have reduced the need for revision surgery.
However, if an ankle replacement is performed on a limb with poor alignment, there’s an increased risk of revision surgery or ankle fusion. This approach introduces more complexities, such as the need for a bone graft to retain leg length after implant removal.
Starting with an accurate diagnosis and a holistic approach to each patient is vital to the success of ankle replacement surgery. This approach significantly decreases the risk of future replacement surgeries or progression to fusion.
To learn more about total ankle replacement, as well as what you can expect prior to, during, and after the surgery, please visit our Total Ankle Replacement page.
Fusion (Arthrodesis)
Arthrodesis involves joining the bones of a joint to create one solid bone instead of multiple. The purpose of this surgery is to reduce discomfort by immobilising the arthritic joint. During arthrodesis, your surgeon removes any damaged cartilage and permanently joins the two joints using pins, plates, screws, or rods. These bones gradually fuse together, similar to how a fractured bone heals. This results in relief from discomfort as the damaged joint is eliminated.
While arthrodesis typically brings positive results, issues may occasionally arise. For instance, the joint might not fuse properly, or the devices holding the bones in place may fracture. Broken hardware is not likely to cause pain, but the nonunion of bones can lead to discomfort and swelling. In such cases, a secondary procedure may be necessary to repair the joint, which could involve putting in a bone graft and/or new hardware. Adhering to your doctor’s recovery instructions after the initial operation is essential for achieving the best outcomes.
In a small number of patients, wound healing issues may occur. However, these can be addressed with proper wound management, including dressing changes or additional surgery. It’s worth noting that decreased ankle mobility after fusion can place excessive strain on neighbouring joints, potentially leading to arthritis later in life.
At our clinic, we will thoroughly explore all surgical options and determine which one aligns best with your specific needs, providing pain relief, restoring mobility, and improving your overall quality of life.
For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.
X-ray facilities at all locations | Urgent appointments available if necessary.
Professor Munjed Al Muderis is an orthopaedic surgeon and a clinical professor at Macquarie University and The Australian School Of Advanced Medicine. He specialises in hip, knee, trauma and osseointegration surgery. He is a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group of Australia.