Updated: 10/31/2022

Ankle Arthritis

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
7
N/A
N/A
Questions
19
0
0
0%
0%
Evidence
33
0
0
0%
0%
Videos / Pods
2
0%
0%
Cases
5
0%
Techniques
2
Topic
Images
https://upload.orthobullets.com/topic/7037/images/stage_i.jpg
https://upload.orthobullets.com/topic/7037/images/stage_ii.jpg
https://upload.orthobullets.com/topic/7037/images/stage_iiia.jpg
https://upload.orthobullets.com/topic/7037/images/stage_iiib.jpg
https://upload.orthobullets.com/topic/7037/images/stage_iv.jpg
  • summary
    • Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis.
    • Diagnosis is primarily made with plain radiographs of the ankle. 
    • Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity.
  • Epidemiology
    • Incidence 
      • less common than OA of knee and hip
  • Etiology
    • Pathophysiology
      • causes include
        • post-traumatic arthritis
          • most common etiology, accounting for greater than 2/3 of all ankle arthritis
        • primary osteoarthritis
          • accounts for less than 10% of all ankle arthritis
        • other etiologies include rheumatoid arthritis, osteonecrosis, neuropathic, septic, gout, and hemophiliac
      • pathoanatomy
        • nonanatomic fracture healing alters the joint contact forces of the ankle and changes the load bearing mechanics of the ankle joint
        • loss of cartilage on the talar body and tibial plafond results in joint space narrowing, subchondral sclerosis and eburnation
  • Anatomy
    • Osteology
      • a ginglymus joint that includes the tibia, talus, and fibula
      • talar dome is biconcave with a central sulcus
    • Range of motion
      • ankle dorsiflexion: 20 degrees
      • ankle plantar flexion: 50 degrees
      • Takakura Classification
      • Stage I
      • Early sclerosis and osteophyte formation, no joint space narrowing
      • Stage II
      • Narrowing of medial joint space (no subchondral bone contact)
      • Stage IIIA
      • Obliteration of joint space at the medial malleolus, with subchondral bone contact
      • Stage IIIB
      • Obliteration of joint space over roof of talar dome, with subchondral bone contact
      • Stage IV
      • Obliteration of joint space with complete tibiotalar contact
  • Presentation
    • Symptoms
      • pain with weight bearing
      • loss of motion
    • Physical exam
      • joint effusion
      • pain with ROM testing, loss of ROM compared to the contralateral side
      • angular deformity may be present depending on the history of trauma
  • Imaging
    • Radiographs
      • recommended views
        • weight bearing AP, lateral, and obliques
      • radiographic findings include
        • loss of joint space
        • subchondral sclerosis and cysts
        • eburnation
        • possible angular deformity
  • Treatment
    • Nonoperative
      • activity modification, bracing to immobilize the ankle, and NSAIDS
        • indications
          • indicated as first line of treatment in mild disease
          • single rocker sole shoe modification can improve gait and pain symptoms
          • Arizona brace (gauntlet ankle brace)
    • Operative
      • surgical management
        • indications
          • indicated upon failure of conservative treatment in a patient with radiographic evidence of ankle arthritis
  • Techniques
    • Ankle debridement with anterior tibial/dorsal talar exostectomy
      • indications
        • mild disease with pain during push off
    • Distraction arthroplasty
      • controversial
      • ideal candidate younger than 45 yrs with post-traumatic arthritis
      • indications
        • well-preserved ankle ROM
        • moderate to severe arthritis
        • congruent tibiotalar surface
        • also for partial AVN talus
    • Supramalleolar osteotomy
      • indications
        • near-normal ROM
        • minimal talar-tilt or varus heel alignment
        • medially focused ankle arthritis
          • stage 2 or 3a according to the Takakura-Tanaka classification for varus-type osteoarthritis
    • Arthrodesis
      • indications
        • posttraumatic or inflammatory arthritis, malalignment (with osteotomy)
        • young, high demand laborers
      • outcomes
        • reliable relief of pain and return to activities of daily living
      • complications
        • long term studies demonstrate subtalar arthrosis
          • 50% of patients demonstrated subtalar arthrosis 10 years following ankle arthrodesis in one study
        • risk factors for nonunion include smoking, adjacent joint fusion, history of failed previous arthrodesis, and avascular necrosis
        • revision arthrodesis union rates are 85% or greater
    • Arthroplasty
      • indications
        • patient selection is crucial
          • indications
            • posttraumatic or inflammatory arthritis, elderly patient
          • contraindications
            • uncorrectable deformity, severe osteoporosis, talus osteonecrosis, charcot joint, ankle instability, obesity, and young laborers increase the risk of failure and revision
      • techniques
        • new generation arthroplasty minimizes bony resection, retains soft tissue stabilizers, and relies on anatomic balancing
      • outcomes
        • recent 5-10 year outcome studies demonstrate up to 90% good to excellent clinical results, long-term studies are still pending on the newest generation of ankle arthroplasty
        • increased gait speed and stride length
      • complications
        • syndesmosis nonunion
        • include wound infection, deep infection, and osteolysis

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Technique Guides (2)
Flashcards (7)
Cards
1 of 7
Questions (19)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ13.191) A 43-year-old woman complains of ankle pain with weightbearing for the last 2 years. She plays tennis and regularly walks 5 miles a day for exercise, but has had to give up these activities over the last few months because of pain. NSAIDs and bracing have provided her temporary relief. An injection into her ankle joint provided temporary near-complete relief. She would like to proceed with a surgical intervention following a shared decision making discussion. Which of the following options will most likely provide pain relief and allow her to return to her previous activity level?

QID: 4826
FIGURES:

Arthroscopic debridement

7%

(367/5508)

Supramalleolar osteotomy

63%

(3495/5508)

Talar resurfacing

2%

(123/5508)

Total ankle replacement

8%

(446/5508)

Ankle arthrodesis

19%

(1036/5508)

L 3 C

Select Answer to see Preferred Response

(OBQ13.245) Medial opening wedge supramalleolar osteotomy is considered a treatment option for ankle osteoarthritis. In which of the following scenarios would this procedure be most appropriate?

QID: 4880

Complete obliteration of the ankle joint space with bone-on-bone contact; valgus ankle alignment

1%

(58/4496)

No joint-space narrowing, but early ankle joint sclerosis and osteophyte formation; valgus ankle alignment

9%

(386/4496)

Symptomatic narrowing of the ankle joint space medially; varus ankle alignment

81%

(3621/4496)

Symptomatic narrowing of the ankle joint space laterally; neutral ankle alignment

4%

(168/4496)

Obliteration of the medial joint space that extends to the roof of the talar dome; varus ankle alignment

5%

(225/4496)

L 2 B

Select Answer to see Preferred Response

(SBQ12FA.32) A 52-year-old male sustains a talus fracture that is treated with immediate reduction and internal fixation. He subsequently develops talar dome avascular necrosis and is treated with the surgery shown in Figures A and B. He shows no evidence of healing at 12 months postoperatively and has continuous pain with ambulation; his incisions are well-healed and his subtalar motion remains full and pain-free upon examination. What is the most appropriate treatment for him at this time?

QID: 3839
FIGURES:

Use of an external bone stimulator

4%

(82/2195)

Dynamization of the implants to allow controlled compression

2%

(48/2195)

Removal of the implants and placement of a hindfoot arthrodesis nail or plate

13%

(276/2195)

Injection of platelet rich plasma

0%

(8/2195)

Revision ankle arthrodesis with bone grafting as needed

80%

(1756/2195)

L 2 C

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ11.10) The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology?

QID: 3433

Midfoot prominences associated with Charcot arthropathy

18%

(560/3062)

Severe toe-tip ulcerations

8%

(250/3062)

End-stage tibiotalar arthritis with limited motion

60%

(1841/3062)

Fixed ankle dorsiflexion deformity

9%

(267/3062)

Fixed planovalgus deformity

4%

(127/3062)

L 3 C

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ08.197) A 65-year-old man complains of ankle pain refractory to bracing, physical therapy and NSAIDS. A radiograph is provided in Figure A. He is treated with ankle arthroplasty but continues to have pain and limited ambulation 10 months following surgery. Physical exam is notable for well healed incisions and no instability with anterior drawer and inversion testing. A current radiograph is provided in Figure B. Which of the following is the most likely cause of the continued pain?

QID: 583
FIGURES:

Improper surgical procedure

7%

(247/3754)

Component loosening due to polyethylene wear

10%

(386/3754)

Lateral ligament failure

2%

(62/3754)

Syndesmotic nonunion

79%

(2983/3754)

It is normal to have continued pain at 10 months following this surgery

2%

(62/3754)

L 1 D

Select Answer to see Preferred Response

(OBQ08.115) At long-term follow-up, patients undergoing the procedure shown in Figure A have been shown to have significant rates of findings of which of the following?

QID: 501
FIGURES:

Need for revision surgery

2%

(83/3559)

Hardware failure

2%

(88/3559)

Need for crutches or walker

1%

(21/3559)

Ipsilateral knee and/or hip degenerative changes

7%

(262/3559)

Ipsilateral midfoot and/or hindfoot degenerative changes

87%

(3096/3559)

L 1 B

Select Answer to see Preferred Response

(OBQ08.89) A 57-year-old male has right ankle pain for 6 years and has failed conservative management. Radiographs of the ankle are shown in Figures A and B. Which of the following is a contraindication for a total ankle arthroplasty?

QID: 475
FIGURES:

Posttraumatic arthritis

1%

(25/2397)

Reconstructible ankle ligament damage

3%

(76/2397)

Neuropathic joint disease

87%

(2085/2397)

Inflammatory arthritis

8%

(195/2397)

Age greater than 50 years old

0%

(9/2397)

L 2 D

Select Answer to see Preferred Response

Evidence (33)
CHAPTERS (1)
VIDEOS & PODCASTS (3)
CASES (5)
EXPERT COMMENTS (19)
Private Note