Ankle arthritis typically is a product of ankle trauma, ankle instability, inflammatory conditions such as Rheumatoid Arthritis, but regardless of the cause of ankle arthritis there are two main options for treating end stage ankle arthritis:
1. Ankle Fusion
2. Ankle Replacement
There have been significant strides in improving Ankle Replacement (eg, technique, implant R&D, and surgeon training) over the past 10 years now such that ankle fusion can no longer be easily stated as being the gold standard for treating end stage ankle arthritis. Some of the factors that go into choosing the right method of treatment for the patient depends on the pathology, angular deformity, patient goals, & comorbidities.
Few differences between replacement and fusion is post surgical motion, adjacent joint disease and post surgical rehab.
Typical Rehab Schedule for Ankle Fusion
1. Short leg splint (ie, soft cast) for 2 weeks, non-weight bearing via use of crutches, scooter, or walker.
2. Weeks 2-6, surgical boot but still non-weight bearing
3. Weeks 6-8, start on partial progressive weight bearing program
4. At 3-6 months, start strength training, the best of the best usually at 12 months.
65 year old female with end stage ankle arthritis that occurred from a residual ski accident 20 years ago. Underwent multiple prior surgeries and had developed Chronic Regional Pain Syndrome. After having failed conservative care the patient opted to undergo ankle fusion. Below are pre and post xrays. The videos show her before ankle fusion surgery and 6 months after her ankle fusion. Her pain is marginal and she is extremely happy with her mobility and level of activity post surgery!
Before ankle fusion
6 months after ankle fusion!
Typical Rehab Schedule for Total Ankle Replacement
1. Short leg splint (ie, soft cast) for 2 weeks, non-weight bearing but may stand for transfers. Usually crutches, scooter, walker.
2. If the incision has healed you can start walking at 2 weeks after surgery with a surgical boot.
3. Physical therapy starts anywhere from 2-4 weeks after surgery.
4. Transition out of the surgical boot into normal shoes at 6 weeks from surgery.
5. Rehab & PT may last up to 3-6 months, most are back to most activities by 6 months and the best of the best is usually at 12 months.
Total Ankle Replacement with Ligament Reconstruction
75 year old male with cavovarus ankle arthritis. Underwent ankle replacement with lateral ligament stabilization via modified Brostrom internal brace for ATFL CFL. Walking with minimal pain at 2 weeks!
Walking at 2 weeks after surgery!
6 weeks after surgery!
Kind remarks from patient about his Ankle replacement
Total Ankle Replacement
65 year old male with advanced ankle arthritis. Prior history of breaking his leg that healed malaligned. Underwent Total Ankle replacement using the Wright Medical Prophecy Infinity Adaptis implant. He is 8 weeks out from surgery, doing exceptionally well, back to biking and walking without pain. We cleared him today to return to flying his planes!
Total ankle replacement with ligament stabilization procedure
55 year old female with advanced ankle arthritis and ankle instability. Underwent ankle replacement with ankle ligament stabilization. She is now 5 months out and doing great!
Total Ankle Replacement with Minimally Invasive Calcaneal Osteotomy
83 year old male who had a long history of ankle pain, tried bracing but the pain continued to worsen and thus decided to have his ankle replaced. Due to his valgus deformity with subfibular impingement he underwent a Total Ankle Replacement using the Wright Medical Prophecy Infinity implant with MIS medializing calcaneal osteotomy. He is almost 2 years from his surgery and is 100%. Moreover, he is back to his hobbies such as pheasant hunting, which he could not do prior to his surgery.
Total Ankle Replacement at 1 year, doing great!
Staged Total Ankle Replacement Surgery
71 year old female who had severe ankle pain and instability. Underwent a staged procedure to include: 1. Peroneal brevis repair with stem cell and amniotic membrane 2. modified Brostrom internal brace for ATFL and CFL with stem cell 3. Total ankle replacement with medializing calcaneal osteotomy and stem cells. She is currently 1 year out and doing excellent, she is back to all of her desired activities such as golfing and can partake in her daily walks with no pain or instability! Below are her xrays at 1 year from surgery and her initial xrays.
Total Ankle Replacement
73 year old female with severe advanced ankle arthritis. Underwent total ankle replacement with stem cells. Intraoperatively she had a fracture in her tibia that required screw fixation which slowed down her rehab slightly, regardless, she did exceptionally well. She is currently 6 months out from her procedure and is back to her activities with no ankle pain. She is very happy with her results!
68 year old male with end stage arthritis of his subtalar joint (ie, joint beneath the ankle). He had tried all conservative options but still had debilitating pain and was not able to do things such as hike and fly fish.
We decided the best option would be subtalar fusion. He is 3 months out and healing well! He is back to his activities, no longer has the debilitating pain that usually would “stop him in his tracks.” He’s very happy with his results!
The MRI photo depicts his advanced arthrosis and the xray with the screws show a nice developing fusion mass!
When people think of fusion they think their foot won’t move, but as can be seen in the video thats not the case!