Doc-to-Doc: Ankle Arthritis
Dr. Kenneth J. Hunt has recently joined Stanford as Assistant Professor of Orthopaedic Surgery. His areas of clinical specialty include: sports injuries of the foot and ankle, foot/ankle trauma (fractures), foot and ankle arthritis, deformity correction, and tendon disorders. To contact Dr. Hunt about speaking engagements, please send him an email. For patient referrals, contact the Referring Physician Concierge Service by phone at 866-742-4811, via fax at 650-320-9443, or send and email to referral@stanfordmed.org.
Millions of Americans have been diagnosed with ankle arthritis, a major cause of disability, pain, dysfunction, muscle deconditioning, and limb deformity. The effects of ankle arthritis can be physically and mentally disabling for patients. Advances in our understanding of ankle biomechanics, disease pathogenesis, and implant materials have led to improved treatment options and clinical outcomes. Early stages of ankle arthritis can often be successfully treated with diligent adherence to physical therapy protocols and intra-articular injections with corticosteroids and/or hyaluronic acid. When non-operative measures fail to improve conditions, the following surgical options are available:
Total ankle replacement (TAR) – Made popular in the
1970s, the majority of the early implants were unsuccessful,
leading to early failures and many salvage procedures. In recent
years, improvements in TAR implant design, material,
and instrumentation have led to improved surgical outcomes.
TAR can result in a greater functional outcome than fusion because
motion is preserved in the ankle and the adjacent
joints in the foot. The ideal candidate for TAR is a non-obese,
non-smoking patient who is older than 50 years and who
does not engage in hard impact activities. Early results of currently
available TAR implants are promising and long term results
are continuously under investigation.
Ankle fusion – A highly successful procedure that can produce long-lasting pain relief and help restore ankle function. This procedure is for patients who are not candidates for TAR. In suitable patients, high union rates are achieved using an arthroscopic-assisted method which reduces soft tissue stripping and post-operative pain. For patients requiring ankle fusion in the presence of an associated infection or compromised soft tissues, ring fixators have resulted in successful ankle fusion with the added benefit of early weight bearing.
Ankle realignment procedure – An alternative treatment for younger, more active patients with whom fusion or TAR is not ideal. Tibial realignment osteotomies produce good clinical results with return to full activity in the majority of patients. Fusion or TAR can be successfully postponed with realignment surgery in patients with ankle malalignment and arthritis. Ankle arthritis is a common and potentially debilitating problem. While ankle fusion is the current standard definitive surgical treatment in most patients, we are finding very good early success with total ankle replacement in appropriately selected patients. Long term results of the latest generation of implants are highly anticipated. Our ultimate goal is allow patients relief from pain and disability with an optimal return to desired employment and recreational activities.
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