A New Solution For The Arthritic Ankle

By George R. Vito, DPM, Floyd L. Pacheco, Jr., DPM, Charles Southerland, DPM, Edgardo Rodriguez, DPM, and Shannon Thompson, DPM

   Arthritis of the ankle can be a painful and disabling condition. Clinicians can effectively treat mild or moderate arthritis with conservative therapies and joint preserving surgical procedures.1-5 Advanced cases that do not respond to more conservative measures require aggressive surgery. Traditional procedures for severe ankle arthritis pain include ankle arthrodesis and arthroplasty with implant. These are lengthy, usually invasive procedures that can successfully treat severe ankle arthritis but they also have some serious surgical risks.    Researchers have reported rates of deep infection and non-union with ankle arthrodesis that range between 5 and 11 percent.6,7 Many patients and surgeons are reluctant to opt for this procedure since eliminating movement at the ankle can produce an aberrant gait and limit the patient’s ability to return to normal activity.    Ankle joint arthroplasty with total joint replacement has its own drawbacks. Most importantly, ankle implants are not yet a realistic option for many patients. There are specific surgical indications for this procedure and not all patients with severe ankle arthritis are candidates for an ankle implant.8 Additionally, there are few surgeons in the United States who have ankle implant training and who regularly perform the surgery. Although ankle replacement may sound like a desirable option, the literature regarding ankle implants suggests that improvements in implant design are needed.9    Accordingly, we sought to evaluate two minimally invasive techniques, ankle arthrodiastasis and joint fluid replacement therapy. These procedures are not joint destructive and provide the podiatric surgeon with an option for patients who are in serious pain but are also reluctant to undergo a fusion procedure. Surgeons have used these procedures separately to treat arthritis of many joints in the lower extremity. While these techniques are relatively new, the early research has been promising.10-13

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