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:
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
- Short leg splint (ie, soft cast) for 2 weeks, non-weight bearing via use of crutches, scooter, or walker.
- Weeks 2-6, surgical boot but still non-weight bearing
- Weeks 6-8, start on partial progressive weight bearing program
- At 3-6 months, start strength training, the best of the best usually at 12 months.
Ankle Fusion
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
- Short leg splint (ie, soft cast) for 2 weeks, non-weight bearing but may stand for transfers. Usually crutches, scooter, walker.
- If the incision has healed you can start walking at 2 weeks after surgery with a surgical boot.
- Physical therapy starts anywhere from 2-4 weeks after surgery./li>
- Transition out of the surgical boot into normal shoes at 6 weeks from surgery.
- 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!
