Overview
Ankle arthritis is less common than hip or knee arthritis. Unlike those joints, ankle arthritis is frequently post-traumatic.
Causes
- Post-traumatic arthritis after malleolar fracture, plafond fracture or chronic instability
- Primary osteoarthritis
- Inflammatory arthritis
- Neuropathic arthropathy
- Sequelae of infection or avascular necrosis
Clinical features
- Pain, usually worse with activity
- Stiffness
- Swelling
- Reduced walking tolerance
- Hindfoot malalignment in some patients
Examination
- Assess alignment of the ankle and hindfoot
- Look for swelling, tenderness and effusion
- Assess sagittal motion and subtalar motion
- Assess ligament stability
- Examine neighbouring joints and gait
Investigations
- Weight-bearing AP, lateral and mortise radiographs
- Hindfoot alignment views when deformity is suspected
- CT for deformity or preoperative planning
- MRI selectively when osteochondral or avascular pathology is suspected
Non-operative treatment
- Activity modification
- Analgesia
- Ankle brace or supportive footwear
- Physiotherapy
- Injections in selected patients
Operative treatment
Joint-preserving options
- Arthroscopic debridement in selected early impingement or focal disease
- Realignment osteotomy if malalignment is contributing
End-stage arthritis
- Ankle arthrodesis
- Total ankle replacement in selected patients
Arthrodesis versus replacement
Arthrodesis provides reliable pain relief but sacrifices motion and may increase stress on adjacent joints. Total ankle replacement preserves motion but has stricter indications and higher concerns regarding implant longevity and failure.
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