Traumatic arthritis is the term used to describe ankle arthritis after an injury. The ankle is a hinge joint that is normally resistant to forming arthritis, as compared to the knee and hip, until it has been injured.
Post traumatic arthritis, which results from the wearing out of cartilage that covers the joint surfaces, leads to bone-on-bone grinding, loss of motion, and bone spurs formation (called osteophytes). It is these destructive changes along with loss of function that results in severe pain and usually limits normal activities.
Early-Stage Traumatic Arthritis Treatments
It is the early stages of traumatic arthritis when non-surgical options are considered to try and slow down the disease progression. Anti-inflammatory medication, rocker bottom shoe modification, Brace Therapy , custom orthotics , and joint injections are often recommended. If these treatments are not successful then arthroscopy may be indicated to remove the prominent bone spurs and reactive tissue that grows and clogs the joint cavity. Scoping a joint can be helpful in those cases where the spurs are scraping the opposing joint surface and leaving grooves or scratches in the remaining cartilage.
End-Stage Traumatic Arthritis Treatments
When arthritis becomes so severe that non-surgical treatments and arthroscopic surgery are no longer able to control the condition, then this is referred to as end stage post traumatic arthritis. Patients at this stage are offered three methods of surgical treatment: Ankle Fusion (also called arthrodesis), Total Ankle Replacement , and Distraction Arthroplasty . Ankle fusion, a more traditional approach to the problem, joins the bones of the ankle together as a solid bone mass. While most of the pain from the traumatic ankle arthritis can be eliminated, it is at the expense of losing all motion at the ankle. Ankle replacement, a more modern approach, involves replacing the joint surfaces with man-made surgical components that bind to the bone and work like a joint, thus preserving the motion at the ankle. Although much of the pain is eliminated, demanding activities, such as jumping and running, need to be avoided to promote longevity of the implant. Distraction arthroplasty is a technique that involves attaching a surgical cage device that pulls apart the ankle joint surfaces, permits weight-bearing and allows the joint surfaces to regenerate a layer of newly formed cartilage. The cage device (external fixator) is generally in place for 10-12 weeks while therapeutic range-of-motion exercises are performed on the separated joint. Typically pain is gradually reduced over a one year time interval once the fixator is removed. This technique favors joint with limited joint distortion.
Age Considerations
The age of the patient is an important consideration when evaluating treatments for end-stage traumatic arthritis.
- Distraction arthroplasty is a stronger consideration for those patients in their 20's and 30's because they are able to generate a better quality tissue in the ankle joint.
- Total Ankle Replacement is generally considered for patients over 50 years of age, since the components used can wear out over time and the implant may need to be revised sometime within a 15 year period.
- Ankle Fusion , while durable, has been shown to place stress on adjacent joints of the foot and can cause progressive breakdown of all the joints in the arch and the joint below the ankle (subtalar joint). For this reason, ankle fusion should be delayed as long as possible, but in no case before damage is caused to other joints from abnormal walking. After surgery, use of rocker shoes and orthotics are advised.
Other Types of Ankle Arthritis
There are several other types of arthritis that can also affect the ankle. These include Rheumatoid Arthritis, gout, and other systemic arthritis conditions.
Ankle Joint Deformities (click for more information)
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