Current concepts in the management of ankle arthritis

Abstract

Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.

Keywords: Ankle arthritis; Arthrodesis; Arthroplasty; Arthroscopy; Osteotomy; Replacement; Tibiotalar joint.

Fig. 1

Anteroposterior (AP) and lateral radiographs of an ankle joint indicating severe ankle arthritis with a large anterior osteophyte (white arrow).

Fig. 2

Anteroposterior (AP) and lateral radiographs of an ankle joint indicating severe ankle arthritis with reduced joint space (white arrow), anterior osteophytes (yellow arrow) and sclerosis (red arrow).

Fig. 3

MRI coronal view of an ankle showing an osteochondral defect (red arrow).

Fig. 4

Fluoroscopy guided left ankle corticosteroid injection.

Fig. 5

Photograph showing the standard intra-operative set up for an ankle arthroscopy.

Fig. 6

Intra-operative image taken during an ankle arthroscopy illustrating bleeding subchondral bone.

Fig. 7

a and b – AP plain radiographs of an ankle joint pre- and post-operatively following a supramalleolar osteotomy. The patient had a varus ankle joint alignment with medial ankle joint arthritis (Images reproduced from Takakura Y et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br. 1995; 77: 50–54.¹⁸).

Fig. 8

A lateral plain radiograph of a left ankle showing an Ilizarov frame assisted distraction ankle arthroplasty.

Fig. 9

Intra-operative fluoroscopy images showing AP and lateral views of an ankle joint after an arthroscopic arthrodesis.

Fig. 10

AP and plain ankle radiographs of the same patient, taken approximately 6 months after surgery, demonstrating complete bony fusion.

Fig. 11

AP and lateral plain radiographs demonstrating a fixed-bearing total ankle replacement in situ, along with a simultaneous correction of hindfoot varus using a minimally invasive calcaneal osteotomy, and a first metatarsal dorsiflexion osteotomy.