Unlike hip and knee arthritis, which tends to affect an older to elderly population, ankle arthritis tends to primarily affect a younger patient population. The hip and the knee tend to have cartilage that wears out with time producing arthritis in older patients; however the ankle has a different type of cartilage that is relatively resistant to old age degeneration but very susceptible to the effects of trauma.

Yes, the association of significant ankle trauma has been linked to the development of ankle arthritis and has been linked for a very long time. One common trauma that is known to progress to post traumatic ankle arthritis is an ankle fracture. It is very common to hear about someone that has broken their ankle and then consistently refer to it as their “bad ankle”. The severity of the fracture correlates with the likelihood of developing symptomatic arthritis. Simple non displaced rotational fibular fractures have a low likelihood of going on to symptomatic arthritis while high energy pilon type fractures will progress to ankle arthritis almost 100% of the time.

Over the past 20 years, many studies have looked at the effect of minimal ankle trauma and have found that recurrent low energy trauma can also lead to the development of significant and symptomatic post traumatic arthritis at the ankle. Patients with recurrent ankle sprains in their teens, twenties and thirties have been shown to develop ankle arthritis in their 40s and 50s if the instability is not treated. Additionally, the inflammatory arthropathies like rheumatoid arthritis and lupus occur in the ankle frequently as well. All of these conditions tend to occur in a younger patient population than hip and knee arthritis.

Historically, treatment for ankle arthritis has not been great; however, treatment options have significantly evolved with more options and better outcomes. For early stage arthritis, treatment consists of:

• Physical therapy to strengthen the muscles around the ankle.
• Ankle bracing to provide support and stability
• Medical management with an anti inflammatory either oral or topical to help manage pain.

Corticosteroid injection under ultrasound or fluoroscopic guidance can also be used to treat symptomatic arthritis and can produce 3 to 6 months worth of meaningful pain relief. However, Viscosupplementation has been found to not be particularly helpful in ankle arthritis and has been shown to cause a significant flare reaction, unlike in the hip, knee, and shoulder.

Newer regenerative treatments, such as amniotic allograft, platelet-rich plasma, and stem cell therapy, have shown promising results in alleviating ankle arthritis symptoms.

End stage ankle arthritis, that is arthritis which is unresponsive to all of the treatment modalities previously mentioned, is generally treated with surgery. Historically, the only treatment available for ankle arthritis was an arthrodesis which fused the ankle. By eliminating the joint pain, arthritis is eliminated, but motion is also eliminated as well. This leads to a limp, but more importantly, it causes joints adjacent to the ankle to increase the amount that they move to compensate for the motion lost at the level of the ankle. Multiple studies have shown that over time this leads adjacent joints to become arthritic. On average these joints become significantly arthritic about ten years after an ankle fusion and then progresses on to further significant surgery. Unfortunately, these joints also need to be fused or replaced and the ultimate result is ankle stiffness, a very stiff foot and a not very functional leg, i.e. a peg leg.

Another technique, known as distraction arthroplasty of the ankle, has been used to treat ankle arthritis. This technique involves placing and external fixator, like a scaffold, on the outside ankle and distracting the ankle to create more joint space. Although this technique initially had good results in the literature, mid to long term outcomes have not been as promising and there tends to be continued pain and disability at the level of the ankle post treatment.

Ankle arthroplasty, or total ankle replacement has been an emerging orthopedic technology. Just like the ability to replace shoulders, hips and knees, we have the ability to replace the ankle with a prosthesis. First attempted in the 1960s, the first prosthesis available in the United States was approved by the FDA in 1997. This prosthesis underwent several design changes through its lifespan and results progressively improved. Several more implants were approved in 2007 and have gone through progressive improvements and updates. With each generation of implants, results continue to improve in the short, mid and long term.

Newer systems also have instrumentation that allows for easier and more accurate placement and take the patients anatomy into account with custom made tools for a personalized and bespoke surgery. These improvements also allow for more reproducible surgeries with improved outcomes and longevity of the implant. Newer systems have also taken polyethylene technology into account and are using more durable plastic pieces as a bearing surface leading to increased survival and decrease need for revision surgery. The newest FDA approved and cleared total ankle is the Kinos Axiom total ankle. It introduces significant improvements over previous generation total ankles. This ankle replacement was designed to have a natural articulating geometry that is biomechanically accurate to a normal intact native ankle with continuous surface contact that will mimic and restore normal motion and function. The Kinos ankle provides motion in all three anatomic planes providing significantly more range of motion than all competitors in internal and external rotation as well as inversion and eversion at the level of the ankle. Most importantly the Kinos ankle significantly decreases stresses at the level of the articular surface. Studies have shown that there is and 80% reduction in contact stress and greater than 50% reduction in wear potential of the polyethylene liner because of this. This will ensuree that the Kinos Axion has a longer survivorship than its competitors do. The novel design of the Kinos has lead to significant improvements in implant to bone stability that is substantially better than all of the competitors.

Schedule an Appointment with Our Ankle Specialists

Ankle Replacement in Central New Jersey and the Jersey Shore

If you’re considering ankle replacement, our board-certified foot and ankle surgeons at Seaview Orthopaedics are here to help. We offer a full range of nonsurgical and surgical treatments for ankle arthritis across Central New Jersey and the Jersey Shore.

To schedule an appointment with one our ankle specialists, feel free to schedule online, visit one of our six NJ orthopedic clinics or call (732) 660-6200. We look forward to helping you get back on your feet!