Ankle Replacement Surgery: The Alternatives to Replacement Surgery

Editor's Note: This article was originally written by Andrew Piasecki, M.D.

There are both surgical and non-surgical alternatives to ankle replacement surgery. First line treatments for arthritis of the ankle are non-surgical methods. Several of the non-surgical methods provide relief because they limit motion, thus decreasing the irritation of the arthritic joint. One such method is the use of shoe inserts (orthotics), such as pads and arch supports. The use of an ankle brace or a cane can also help to take pressure and stress off the arthritic joint. An ankle-foot orthrosis (AFO), or a custom-made shoe with a stiff sole and a rocker bottom, can also work by decreasing motion thru the ankle joint. And, although scientific evidence is controversial, the use of certain nutritional supplements, such as glucosamine and chondroiton, might help decrease your pain. Direct injection of medication into the arthritic joint can give up to several months of pain relief. It is important to note that weight control is also an important method of decreasing the stress on the ankle. Although none of these treatments can reverse or cure the deteriorated cartilage, they can provide improved function with decreased pain.

If the non-surgical treatments don't adequately reduce your pain, surgical options can be pursued. The specific surgery that is right for you depends on the extent and pattern of cartilage damage and level of pain associated with the ankle. Alternatives to ankle replacement include: debridement, allograft (cadaver) arthroplasty, distraction arthroplasty, and arthrodesis (fusion). A debridement is essentially "cleaning up the ankle joint" and can be done arthroscopically or through open techniques. This procedure involves the removal of inflamed synovial tissue (joint lining), loose cartilage fragments and osteophytes (bone spurs). In ankles that still have a reasonable amount of normal cartilage remaining, this method can give relief of pain for several months to years. Another surgical procedure is an allograft, where cadaver donated cartilage and bone can be transplanted into your ankle in order to replace focal areas of damaged cartilage. Distraction arthroplasty typically involves a debridement of the ankle followed by application of a wire frame thru the bones above and below the ankle. This apparatus holds the ankle stiff and slightly separated, in order to allow some cartilage healing to occur. For ankles that have diffuse cartilage loss, arthrodesis (fusion) is a procedure where your orthopaedic surgeon takes out the remaining cartilage and stabilizes the joint to allow the bone to heal together and eliminate motion and pain.

Without a doubt, arthritis is a progressive process and once pain is present it is not likely to completely resolve without treatment. This does not mean that all people with ankle arthritis end up having surgery; on the contrary, the decision to proceed with surgery is primarily based upon how much pain you have, your quality of life, and the activities you wish to pursue.

It is important to note that physical therapy can be helpful in controlling and reducing the pain of ankle arthritis. Physical therapy helps by maintaining the flexibility of the joint and keeping the supporting muscle and tendons in good condition. The benefit of therapy, however, will be directly influenced by the severity of the arthritic joint destruction that has occurred. As such, if your ankle arthritis is advanced to the level of being a candidate for ankle replacement, therapy is not likely going to be very satisfactory for you.

There are unfortunately no pills that will "cure" your ankle arthritis, like an antibiotic cure for an infection. Instead, you can achieve pain reduction with anti-inflammatory medications such as ibuprofen or naprosyn. Narcotic pain medications, such as Percocet or Vicodin, are not good choices as a primary treatment as arthritis is a chronic condition and the regular use of these drugs could lead to complications of long-term narcotic use.

Despite some over-the-counter supplement claims, a natural cure for arthritis has not yet been discovered. Some supplements discussed above, such as glucosamine and chondroitin may offer pain reduction similar to anti-inflammatories.

If your ankle is very painful and is affecting the activities you want to do, surgery may be your best option. Be sure to fully discuss and explore all of your treatment options, both surgical and non-surgical, with your orthopaedic surgeon.