Ankle


Frequently Asked Questions

I've been crippled by arthritis in my right ankle. Despite all of my efforts, the pain and stiffness are getting worse instead of better. I do yoga. I get acupuncture. Occassionally I treat myself to a massage. But I've had to give up running, then jogging, now hiking. It's time to do something. I saw a surgeon who gave me two options: fusion or joint replacement. Before I leap, I'm checking to see what kinds of problems come with both of these operations.

Years ago, your only option would have been a fusion. But things are changing in the treatment of severe ankle arthritis. What was once treated with ankle fusion can now be managed with a joint replacement. Improved surgical techniques and better implant designs have made the shift possible. So that's the good news. As you suspected, there are some potential problems. And that's true for any surgery. Let's take a look at the kinds of complications that can occur with either fusion or joint replacement. Fractures, skin and deep wound infections, and chronic pain after surgery are possible with either procedure. Likewise, infection that spreads to the bone called osteomyelitis can develop after any surgical procedure that disrupts bone as these two procedures do. Then there is the risk of cutting or damaging nerves and/or blood vessels. Ankle fusion is well-known for complications such as off angles, poor alignment and deformity, nonunion, and arthritis in the surrounding joints. Altered gait or abnormal walking pattern is typical with an ankle fusion. And of course, activities like jogging or running will never be the same if even possible. Ankle arthroplasty (total ankle replacement) comes with its own set of potential problems. Common complications with ankle joint replacement include loosening of the implant, impingement (pinching), and malalignment. There can also be subsidence (implant sinks down into the bone), the wrong implant size used, and/or excessive wear on any part of the implant. Though rare, the implant can also fracture or break as well. You should know that studies show a fairly high complication rate with both procedures. Ankle replacement has a much higher (sometimes twice as high) complication rate compared with fusion. Surgeons are making efforts to reduce the complication rate. Studies just on complications after these two procedures are helping bring useful data and insights. Your surgeon will review your particular situation. Any specific patient risk factors will be noted and changed if possible. To be honest, surgeon error can be a potential area of concern as well. Selecting the wrong sized implant for joint replacement is possible. Cutting nerves or blood vessels that are difficult if not impossible to see during the procedure is another operator error that could be improved. On the plus side are the benefits of either one of these procedures. Number one is the reduction of pain, not to mention improved motion and function. There's no doubt that complications after either procedure can impact the long-term outcomes. Surgeons do everything they can to maximize the benefits and minimize the problems.

Fabian G. Krause, MD, et al. Impact of Complications in Total Ankle Replacement and Ankle Arthrodesis Analyzed with a Validated Outcome Measurement. In The Journal of Bone and Joint Surgery. May 4, 2011. Vol. 93A. No. 9. Pp. 830-839.

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