Ankle prosthesis surgery

An orthopedic surgery may be necessary if the ankle joint is worn, or if other therapies do not help the symptoms. When this happens, a prosthesis is implanted for the purpose of improving the quality of life.

What are the main symptoms of the disease?

• Pain that is characterized by the following:
  • It develops after waking up in the morning, or when remaining in one position for a long period of time, then it is reduced after moving around a bit (pain at movement initiation).
  • Increase on load and during walking for a longer period of time.
• Decrease or cessation at rest.
• Swelling
• Reduced ability to walk and walking distance
• All of the above may lead to limping.

Which causes lead to the disease?

Degenerative joint wear

In this case, cartilage damage has rheumatological causes, but the common primary arthrosis is also known in terms of the hips, and knees.

The exact cause of primary joint wear (arthrosis) is unknown; even the most thorough examinations cannot identify the cause of cartilage damage in the joint. Biological aging, degenerative changes, and a predisposition for it may play a great role in the development of the disease. However, the disease course may be accelerated by previous surgeries, injuries, inflammations, and developmental disorders.

Post traumatic joint wear

In this case, cartilage damage develops after accidental or repeated injuries. Its development could be traced back to the uneven surfaces that remained after an intraarticular fracture, or a leg fracture without joint involvement, which change the loading axis of the ankle joint.

What causes the disease and what does it mean?

• The biological and mechanical changes, which develop in the ankle joint, intensify each other as in a vicious cycle; the hyalin cartilage coverage of the joint gets thinner and fragmented, and eventually wears out completely.
• Friction increases during movement.
• The intraarticular membrane of the joint capsule gets inflamed by the detaching cartilage bits.
• The production of joint fluid is increased, which leads to tightness.
• The joint’s range of motion is reduced due to the calcification.
• All of the above are followed by the disbalance of bones, tendons and muscles, and various deformities develop.
• Movement and loading become painful, the walking distance is significantly reduced, squatting becomes more difficult.

What are the treatment options?

Non-surgical (conservative) treatment

Aims:

• Reducing pain
• Increasing the joint’s range of motion
• Increasing muscle strength
• Reducing limping

Methods:

• Pharmacological treatment:
  • Anti-inflammatory drugs
  • Painkillers
  • Antispasmodic drugs, relaxants
  • Cartilage repair treatment
• Rheumatological treatments: physiotherapy, medical spa treatment (balneotherapy)
• Exercises enhancing the range of motion

Surgical treatment

The physician may recommend surgery if the conservative treatment methods are no longer effective, and the diagnosis is confirmed by clinical examinations and X-ray scans. It is important to select the time of the intervention, which depends mostly on the patient’s pain tolerance, the condition of the stabilizing musculature, and the level of progression (aggravation).

Types of surgeries which can be performed in case of ankle arthrosis:

• Arthrodesis: once the cartilage surface is shaved, the talocrural joint is fixated by the surgical opening of the ankle joint (arthrotomy), or endoscopy (arthroscopy). Following this, the joint is no longer painful, and patients can walk normally with it, since the ankle joint is already used to the reduced range of motion. Although its disadvantage is that the neighboring joints will sooner or later wear out due to the increased load.
• Implantation of a total endoprosthesis, replacing the ankle joint. The prosthesis could be fixated with the help of bone cement and adequate moulding. The shinbone segment is made of a metal plate, the talar segment is made of a dome like metal, and a special plastic liner with low wear coefficient is placed between them.

The surgical process:

• The patient’s talocrural joint is explored through an incision that is made above the ankle joint.
• The damaged joint surfaces are removed, then the place of the prosthesis is created on the lower leg bones and on the talus in a way that a prosthesis made of tissue friendly plastic, and metal could be fixed with the help of bone cement.
• The amount of bone removal and the size selection of the prosthetic components allow that the axis of the joint, and the adequate tightness of the ligaments can be restored.
• One or two suction drains are inserted into the surgical site due to the accompanying postoperative bleeding.
• The wound is closed after thorough surgical hemostasis.
• Covering dressing and elastic bandage are applied.

What happens if the justified surgical treatment is not performed?

• The pain is expected to increase further.
• The axis deviation and movement disability may aggravate.
• The quality of life keeps deteriorating.
• The effectiveness of a surgery performed later may decrease.