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Dear Doctor: My 75-year-old husband has had arthritis in his ankles for many years. It’s gotten to the point that the pain makes it unbearable for him to be on his feet for more than a few hours. What about surgery? Can you offer some insight as to what can be done?
Dear Reader: Ankle arthritis is a painful and sometimes debilitating condition. It’s marked by the steady deterioration of the connective, protective and supportive tissues in one or more of the three bones that meet to form the ankle joint. Symptoms include tenderness or pain within the joint, redness, a sensation of heat, swelling and reduced range of motion.
Treatment typically begins with nonsurgical approaches, such as changes in activities, losing weight in order to reduce stress on the ankle joints, physical therapy and the use of a variety of medications to address pain and inflammation. If none of these help, then surgery can become an option.
For some people, a minimally invasive procedure known as arthroscopic debridement can be helpful. A tiny camera is introduced via a small incision into the joint, and surgical tools are used to clear the ankle joint of the loose cartilage and other debris the camera has made visible. It’s often done in an outpatient setting, and the individual returns home that same day.
A more intensive surgery, known as arthrodesis, involves the fusion of the bones of the ankle joint. This is achieved by first removing the damaged cartilage and then fixing the joint into permanent position with surgical plates, rods, pins or screws. Over time, the bones of the joint fuse together. This affects range of motion and the individual’s gait, but offers relief from pain.
A third option is a total ankle joint replacement. Known as arthroplasty, it’s a major surgical procedure. The surgeon removes the damaged bone and cartilage of the ankle joint and replaces it with an artificial joint. This eliminates the source of friction and pain while preserving range of motion.
Not that long ago, total ankle joint replacement was considered an experimental surgery. However, advances in the design and materials used in artificial ankle joints, as well as in surgical instruments and techniques, have moved the procedure into the mainstream. It’s still not as common as hip or knee replacement, and patients must meet a somewhat narrow set of criteria to be eligible. These include being in good health, not being overweight, and with ankle joints free of deformity or misalignment.
Although patients return home soon after surgery, the recovery period is significant. Patients are
in a splint or cast for the first month, and they must not put weight on the foot. Complete recovery, which includes extensive physical therapy, takes at least a year. As with all surgeries, short- and long-term complications can occur. The risks and benefits of the surgery vary depending on the age and general health of the patient. It’s important to find an experienced surgeon you are comfortable working with, and to be prepared to commit to what is a long and gradual recovery process.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.