Surgery for Arthritis in the Ankle

If pain, stiffness, and swelling caused by ankle arthritis do not respond to medical treatment, orthopaedic surgeons at NYU Langone may recommend surgery to clean out the arthritic joint, fuse and stabilize a painful joint, or replace the arthritic joint with a prosthetic one.

Debridement

If ankle arthritis is diagnosed when damage is mild to moderate, surgeons may perform a procedure called debridement to “clean out” any bone spurs or fragments of cartilage from the joint. Bone spurs, or osteophytes, can develop in arthritic joints when cartilage breaks down and bone rubs against bone. This friction prompts the body to create more bone to repair the damage; without cartilage to act as a buffer, the new bone spur rubs against soft tissues in the joint, causing even more pain. 

Surgeons can remove bone spurs as well as stray pieces of cartilage or other soft tissue from the ankle joint using either arthroscopic surgery, which is a minimally invasive technique, or a traditional open surgery, which requires a larger incision. This decision is made by you and your surgeon, and it depends on how much bone or tissue needs to be removed from the ankle. If bone spurs or other fragments are small, an arthroscopic approach is likely to be appropriate. 

In an arthroscopic procedure, a surgeon inserts a thin, flexible arthroscope—an instrument equipped with a camera and a light source—through a small incision in the ankle. The camera broadcasts images of the inside of the joint onto a monitor that a surgeon uses to guide small surgical instruments to the arthritic joint through a second small incision. The surgeon then uses these instruments to remove bone spurs or other tissue that may be irritating the joint and causing pain. 

If your diagnostic X-rays indicate that the bone spurs are too big to remove arthroscopically, the surgeon performs an open procedure to access the arthritic joint directly. 

Regardless of the surgical approach, debridement can lessen pain and improve the range of motion in the ankle by removing bone and tissue that interferes with the function of the joint.

Debridement is performed under general anesthesia, which means you are asleep, or spinal anesthesia, which blocks pain signals below the waist while you are awake, depending on your preference. Most people can return home using crutches on the day of surgery and must wear a splint for one or two weeks to keep the ankle stable. Your doctor schedules a follow-up appointment 10 to 14 days after surgery to ensure that your ankle is healing well. 

The total recovery time after ankle debridement depends on how old you are, whether the procedure was arthroscopic or open, and how much bone or other material was removed.

Joint Fusion

If ankle arthritis is causing significant pain that medication or a brace does not alleviate, your doctors may recommend surgery to fuse bones in the ankle joint. Joint fusion permanently joins bones around the arthritic joint or joints by using metal screws and possibly plates. Over time, the bones heal and fuse together as one solid bone, eliminating painful movement between the bones. After the fusion heals, your doctor may remove the screws or plates used to fix the bones into place, depending on the location of the fusion.

Joint fusion is performed under general or spinal anesthesia. It may require a night in the hospital for observation. Pain management specialists can help to keep you comfortable as you recover. 

Doctors give you a supportive splint and crutches because it’s important to avoid putting weight on the ankle. At a follow-up appointment 10 to 14 days after surgery, doctors swap the splint for a removable boot. You should expect to be on crutches and wear the boot for another three months.

Total Joint Replacement

Surgeons recommend total joint replacement if arthritis has caused significant damage to the ankle joint, limiting your ability to participate in everyday activities. In this procedure, surgeons replace the bones of the ankle joint with durable plastic and metal parts. These prosthetic parts mimic the motion of a healthy joint, restoring function and eliminating the pain caused by arthritis. 

Using general or spinal anesthesia, surgeons make an incision above the ankle joint, then remove the damaged bones and cartilage. Two metal pieces are implanted to replace the movable joint, and a plastic spacer is inserted between them to ensure that the joint has a smooth gliding motion. The incision is closed with stitches. 

After surgery, our pain management specialists ensure that you have the medication you need to remain comfortable while your ankle begins to heal. Our doctors recommend remaining in the hospital overnight for observation. 

When you are discharged from the hospital, doctors provide you with a supportive splint that you wear for at least two weeks. Most people also use crutches during this time to avoid putting weight on the foot and ankle. Doctors schedule a follow-up appointment after 10 to 14 days to assess how well the foot is healing and determine whether you should continue to wear the splint to make sure the ankle heals completely. When the ankle has healed, doctors recommend four to eight weeks of physical therapy as you recover strength, flexibility, and range of motion.

Many prosthetic joints last for years without wearing out or causing joint implant complications. However, in some instances a prosthetic joint may wear out and the joint becomes unstable. Your surgeon may schedule annual follow-up appointments after total ankle joint replacement surgery to monitor the implanted joint and, if necessary, explore surgical options to repair or replace aging parts.

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