By Dr. T. Jay Kleeman, Coastal Orthopaedics
Although there are many causes of arthritis, such as arthritis related to previous injury, age-related degeneration, inflammatory types such as gout or rheumatoid disease, or infectious, all forms involve a loss of the natural cartilage coating of the joint and a variable amount of pain, stiffness, instability, and deformity.
Each joint involved with arthritis has a unique constellation of problems and consequences for the patient. The treatment options for arthritis of the ankle may be quite different from those for the knee or shoulder.
Like my patients, I prefer to exhaust non-surgical treatment options before resorting to surgery, as surgery caries risks and even in the best of circumstances may produce a lengthy recovery.
Treatment of arthritis does depend on the type of arthritis being treated. The most common type is degenerative arthritis or osteoarthritis. All though it is a simplification to call this a “wear and tear” of the joint, this is a convenient way to think of the disease. In a sense, we are wearing out the “tread of our tires” or wearing out the “Teflon coating of our frying pans”. Although, we, as yet, do not have a way of curing the disease or of replacing worn out cartilage in all but small areas of certain joints, our goal is to relieve pain and improve function.
If non-operative treatments fail, surgery is required. For earlier forms of degenerative arthritis, minor surgery such as arthroscopy may be an option. In these procedures, tiny incisions are made, in the operating room, through which a fiberoptic camera and long thin instruments are inserted often only using local anesthesia. The recovery is often only a few weeks and requires a minimum of time off the feet.
Moderate degenerative arthritis with deformity may require soft tissue procedures to restore strength and stability, osteotomies or bone cuts to realign the joint while preserving motion, or more experimental procedures such as distraction arthroplasty, where an external frame with pins and wires is applied to the ankle for several weeks to put tension on the joint and help restore the cartilage surfaces.
For advanced arthritis, there are also experimental procedures in which bone and cartilage surfaces are transplanted from a cadaver ankle joint to maintain joint motion. However, the two most common procedures done when the joint has completely worn out are joint replacement, where the joint is resurfaced with carefully engineered metal and plastic parts and arthrodesis or fusion, where the two sides of the joint are joined together to become solid.
In most cases of advanced arthritis, arthrodesis or fusion remains the worldwide gold standard. Although these procedures need to be done by skilled and experienced surgeons, in order to insure successful fusion and proper alignment, they are predictable and durable procedures that can significantly improve the patient’s lifestyle. Many patients can carry out the majority of his or her daily activities with often little more than a supportive shoe.