Ankle-altering surgeries
With severe and intractable ankle damage, surgical approaches may be used that that alter the fundamental structure of the ankle to increase function and reduce pain.
Bone Fusion Surgery
Bone fusion is a well-established procedure for treating end-stage arthritis of the ankle. The most common fusion is of the talus (3 in the diagram) with the tibia (1 in the diagram). Fusions involving the calcaneus (4) along with the talus and tibia are fairly common as well.
For fusion, the surgeon removes the cartilage at the joint between bones (for example, with a tibiotalar fusion the cartilage marked as 2 on the figure) and fixes the bones so that they remain in contact with one another. Over time, the bones grow together, in a process similar to the healing of a fracture in a single bone. Fusions may be performed arthroscopically or with open surgery
Fusion effectively eliminates the joint that was formerly present between the fused bones, therefore eliminating the pain associated with movements at that joint. In eliminating the ankle joint, the mechanics of walking are also therefore altered. There is concern that this may lead to arthritis of the remaining joints of the foot over the long term.
Comparisons of ankle replacements and fusions suggest that which option is best may depend on the characteristics and preferences of individual patients and their surgeons.
Bibliography:
Ferguson, Z., Anugraha, A., Janghir, N., & Pillai, A. (2019). Ankle arthrodesis: A long term review of the literature. Journal of Orthopaedics, 16(5), 430-433.
Image Credit: Danvasilis, CC BY-SA 4.0
Total Ankle Replacement
In recent years, replacement of the ankle joint with an artificial joint has become a common alternative to fusion for end-stage ankle arthritis. There are a number of different designs and manufacturers of replacement ankles, and the technology is constantly developing.
With ankle replacement, portions of the talus and adjacent tibia are removed and replaced with synthetic parts of metal and plastic. This ameliorates the pain formerly caused by movement at the original (natural) joint. Unlike with ankle fusion, a (synthetic) ankle joint is maintained, which should allow for a more natural walking motion.
Comparisons of ankle replacements and fusions suggest that which option is best may depend on the characteristics and preferences of individual patients and their surgeons.
Survival of replacement ankles appears to be good for at least ten years in most cases.
Read about ankle replacements at the Hospital for Special Surgery.
Image Credit: FA RenLis, CC BY-SA 3.0