Ankle arthritis - surgery and treatment options

The treatment of ankle arthritis depends on the severity of symptoms, the degree of joint damage, the cause of the arthritis, ankle alignment and the condition of the surrounding foot.

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There is no single operation that is appropriate for every patient. Treatment ranges from activity modification and physiotherapy through to ankle replacement, ankle fusion and complex reconstructive surgery.

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When is surgery considered?

Surgery may be considered when ankle arthritis causes persistent symptoms despite appropriate non-surgical treatment. Factors that may influence the decision include:

• pain

• stiffness

• walking limitation

• effect on work

• effect on exercise and sport

• sleep disturbance

• progressive deformity

• failure of non-operative treatment

• the overall condition of the ankle and foot

 

The decision should be based on symptoms and function rather than an X-ray alone.

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What operations are available?

Depending on the individual circumstances, surgery may include:

• ankle arthroscopy

• corrective osteotomy

• ankle replacement

• ankle fusion

• ligament reconstruction

• tendon procedures

• complex hindfoot reconstruction

• revision surgery

 

Ankle arthroscopy

Arthroscopy involves using small incisions and a camera to assess and treat problems within the ankle.

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It may be useful for selected patients with early degenerative disease, impingement, loose bodies or associated cartilage problems.

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Arthroscopy is not generally a solution for advanced ankle arthritis with extensive cartilage loss.

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Corrective osteotomy

In selected patients, the alignment of the ankle can contribute significantly to symptoms and abnormal loading. 

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An osteotomy (sometimes known as a supramalleolar osteotomy or SMOT) changes the position of a bone to improve alignment and redistribute load. It may sometimes be used in patients with arthritis and significant deformity, depending on the circumstances.

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Ankle replacement

Ankle replacement replaces the damaged joint surfaces with an artificial joint. The aim is to reduce pain while retaining movement at the ankle. Ankle replacement may be considered for selected patients with advanced symptomatic ankle arthritis.

Read the detailed [ankle replacement surgery guide].

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Ankle fusion

Ankle fusion removes painful movement by joining the bones of the ankle together. It remains an important option for selected patients with advanced arthritis.

Read more about [ankle fusion for arthritis].

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Ankle replacement versus fusion

Replacement and fusion have different advantages and limitations. The decision depends on:

• age

• activity

• alignment

• bone quality

• deformity

• stability

• previous surgery

• associated arthritis

• individual expectations

Read the detailed [ankle replacement versus ankle fusion comparison].

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Complex ankle arthritis

Some patients have more than isolated cartilage loss. Complex cases may involve:

• previous fracture

• deformity

• bone loss

• instability

• previous infection

• retained metalwork

• subtalar arthritis

• midfoot arthritis

• previous failed surgery

 

In these circumstances, treatment may require a combination of procedures.

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Can surgery be avoided?

Sometimes.

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Non-operative treatment may include:

• physiotherapy

• activity modification

• footwear

• orthotics

• medication

• injections

 

The objective is to control symptoms and maintain function for as long as possible. However, if symptoms remain significantly disabling despite appropriate treatment, surgery may become a reasonable option.

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How do I choose between ankle replacement and fusion?

There is no universal answer.

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The decision requires assessment of the individual ankle and foot, together with your priorities and expectations.

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A consultation should consider both the potential benefits and limitations of each option rather than focusing solely on the X-ray appearance of the ankle.

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Frequently Asked Questions

Does severe ankle arthritis always require surgery?

No. Surgery is generally considered when symptoms and functional limitations justify it.

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What is the best operation for ankle arthritis?

The appropriate procedure depends on the individual circumstances, including the cause of arthritis, alignment, bone quality, activity and associated foot problems.

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Can ankle arthritis surgery improve walking?

The aim of surgery is generally to reduce pain and improve function. The expected improvement depends on the procedure and individual circumstances.

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Can ankle replacement preserve movement?

Yes. Unlike fusion, ankle replacement is designed to retain movement at the ankle joint.

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Can ankle arthritis return after surgery?

The answer depends on the procedure. A fusion aims to permanently eliminate movement at the arthritic joint. An ankle replacement is an artificial joint and can undergo wear or other changes over time and may require further treatment.

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Book a consultation

If ankle arthritis is affecting your quality of life and you are considering surgery, a specialist assessment can help you understand the available options and whether surgery is appropriate.

[Book a consultation with Mr Shelain Patel]