New Options in Treating Ankle Arthritis at LRH
February 1, 2011
Arthritis of the ankle is not as common as knee or hip arthritis, but it can be a disabling condition in patients of all ages. Although ankle arthritis can relate to rheumatoid or inflammatory arthritis, it is commonly degenerative in origin. Usually the arthritis is caused by trauma such as a fracture or repeated small injuries, and it progresses until every step is painful. Ankle arthritis can also co-exist with hip, knee and foot arthritis which makes treatment more complex.
Treatments not requiring surgery include non-steroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen), injections with steroids or through therapeutic option for individuals with osteoarthritis known as viscosupplentation (injecting stabilizing material into joints), and bracing. These treatments can be helpful but do little more than provide temporary relief in a severe case.
Surgery is an option, but the choice of surgery depends on the patient as a whole and the other joints affected in the body. Arthroscopic surgery of the ankle is appealing and can be helpful where there are loose bodies, bone spurs, and localized arthritis, but it cannot cure the whole joint. Total ankle replacement (TAR) has become increasingly popular, and can offer a return to pain free motion in many people. The operation involves replacing the worn out joint surfaces with metal and plastic surfaces which are held into the bone as the bone grows into these artificial surfaces. This procedure is difficult, and it appears to last for about 10 to 15 years. Also, there are conditions in which TAR is not recommended. It should not be done in smokers or diabetics who are apt to have poor circulation, cannot be done in younger more active patients (this can cause an early breakdown of the TAR), and cannot be done in an overweight patient or one with an old or active infection. In the right patient the results are gratifying.
In view of the limitations above there is now a third operative option which is being performed at Littleton Regional Hospital. Distraction arthroplasty of the ankle is a combination of arthroscopic debridement (cleaning out) of the ankle joint combined with distraction of the ankle in an external fixator, which is a type of brace. This procedure has been done for about ten years and provides a 75% success rate for at least five years. The surgery involves placing pins in the leg and foot and distracting (pulling apart) the joint surfaces to allow them to heal. After the distraction surgery, patients have a short hospital stay and are able to put weight on the foot with crutches or a walker. Most patients can walk with little or no pain within a few weeks. It does not put nearby joints in the foot and knee at risk as does a fusion, and can be done in younger more active patients as an alternative to TAR.
Using a device that provides rigid immobilization of a fractured bone by means of rods attached to pins that are placed in or through the bone is known as a fixator. Dr. David Lovejoy, orthopaedic surgeon at LRH recently performed this procedure using a foot fixator in a first in the nation procedure using this type of device. Unlike other fixators used for this type of surgery, this fixator offers the ability to move the ankle joint as well as well as distract the joint, a possible advantage in restoring ankle function.
To schedule an appointment with North Country Orthopaedics, please call (603) 259 - 7688. Office hours are Monday through Friday 8:30 am until 4:30 pm.
Taking the lead in treating ankle arthritis at LRH—Dr. Lovejoy, orthopaedic surgeon, with Michelle Piro, who underwent "distraction arthroplasty."
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