Arthritis of the ankle is painful and disabling. It commonly affects those who have previously injured their ankle where the cartilage in the joint has become damaged. As the cartilage wears away, the space between the bones narrows and the bones begin to rub against each other. This causes pain, stiffness and, in some cases, deformity of the ankle joint. Advanced cases that do not respond to non-surgical treatments go on to require surgery.
Limitations of current surgical treatments
The current surgical treatments for this condition include ankle fusion and ankle joint replacement.
Fusion takes the joint away. The bones are permanently joined (or fused) together making the ankle immobile, but taking the pain of arthritis away. Arthroplasty, or joint replacement, preserves the motion of the joint, but replaces the worn surfaces of the ankle with metal and plastic.
Both of these options are lengthy, invasive procedures that can successfully treat severe ankle arthritis, but permanently sacrifice the ankle joint. Unfortunately, neither of these options are ideal in those who are active and retain some ankle movement despite having an arthritic joint.
Ankle distraction arthrolysis – a promising, innovative treatment
Ankle distraction arthrolysis is an innovative procedure for treating ankle arthritis in select patients. Unlike ankle fusion and ankle replacement, distraction arthroplasty is a minimally-invasive technique that focuses on joint preservation and restoration. One major advantage of this procedure is that it still may allow for ankle replacement or fusion if necessary in the future without any increased difficulty.
The first stage of the procedure involves ankle arthroscopy (keyhole surgery of the ankle joint) through two small incisions in the front of the ankle. This is to clean out the joint and remove bone spurs in the front of the ankle that restrict motion. During the same operation, the second stage involves surgical application of an Ilizarov external fixator across the ankle joint. An external fixator or “frame” is a scaffolding assembled around the leg that remains outside the body during treatment. The ankle joint is then distracted (pulled apart by 5 mm) during the operation. The frame has built-in hinges that allow unrestricted ankle mobility.
The frame is worn for 12 weeks to allow slow regeneration of the tissues inside the ankle. It is then removed under sedation in hospital. We know that the ankle improves slowly for up to a year after the frame is removed.
Current literature suggests that 75% of individuals who undergo this procedure do not require any other intervention for their ankle arthritis for two years.1 This procedure is not for everyone with ankle arthritis though. As part of the assessment for whether you are suitable for this procedure, you will need to have your ankle examined, X-rays taken to look at the bones around the ankle as well as the alignment of your leg, and an MRI scan to assess the soft tissues both inside and around your ankle joint.