ANKLE ARTHRITIS WORK RELATED

Dr. Alan G. Lewis

Eastern Oklahoma Orthopedic Center

MKT 16088 Rev B

What is Arthritis? Latin for inflammation of a Joint

Arthros = joint it is = inflammation

Arthritis – leading cause of disability in US Several different types All lead to destruction of the cartilage

Types of Ankle Arthritis

Osteoarthritis (OA) “Wear and tear” Slow and progressive loss of cartilage

Rheumatoid Arthritis Immune system destroys cartilage Often many joints attacked at the same time

Post-traumatic Arthritis Often after injury to ankle (sprain or fracture) Can occur months or years after an injury

What happens in arthritis?

Normal Arthritis

What happens in arthritis?

Normal Arthritis

What happens in arthritis?

Normal Arthritis

What Causes my Pain?

Damaged and Flaking Cartilage Can float in joint and get caught at times Ankle feels unstable and locks at times

Bone on Bone Contact Ankle makes a grinding noise at times Swelling and Stiffness Ligaments loosen and ankle feels unstable

Bone spurs or extra bone around joints Loss of ankle motion Spurs can hit each other causing severe pain

episodes

What are my symptoms?

Pain worse with prolonged exercise/activity worse with first steps after resting

Stiffness Morning stiffness the worst Joint is stiffer/harder to move over time

Swelling by end of the day Joint feels unstable at times and “gives

out” Episodes of severe pain and joint locking

X-ray changes in arthritis

Normal Mild arthritis

X-ray changes in arthritis

Severe arthritisModerate arthritis

MRI changes in arthritis

Treatment Goals Relieve pain/inflammation Slow disease progression

Improve quality of life Restore/maintain functional

independence

Treatment Options Medications Lifestyle changes Physical Therapy Bracing

Surgery

Medications Pain relievers (tramadol; opioids) Non-steroidal anti-inflammatory drugs

COX-2 selective Non-selective anti-inflammatories

Nutritional supplements Glucosamine/chondroitin sulfate Fish oil/vitamin E

Joint Injections Cortisone Hyaluronic acid? Platelet rich plasma?

Medications

Lifestyle Changes Avoidance of impact activities

Running, impact aerobics, treadmills Non impact exercise

Swimming Biking Yoga

Cane or walker Weight loss

Ankle sees 5X body weight

Physical Therapy Improve ankle motion

Stretching routines Improve ankle strength

Non impact exercises Home exercise program

Decrease pain and swelling Electrical stimulation Heat and cold therapies Massage

Brace Options Shoe modifications

Inserts Rocker soles

Non fixed supportive braces Lace up ankle braces Compression wraps

Fixed supportive braces Posterior splints Circumferential braces

Non fixed supportive braces

Cloth lace up Plastic hinge

Fixed Supportive Braces

Posterior splint Circumferential

Shoe modifications

Surgical Treatments• Arthroscopic Debridement

– Early stages– Small incisions/camera used to clean joint

• Arthrodesis (fusion)– Advanced arthritis– Fuse joint into single bone– Good outcomes, long recovery from surgery

• Arthroplasty (Joint replacement)– Advanced arthritis– Replace joint with implant– Preserves joint motion, but implant may loosen or

fail over time

Arthroscopic Debridement

Arthroscopic debridement

Arthroscopic debridement

Ankle Arthrodesis (fusion)

Ankle Arthrodesis (fusion)

Ankle Arthrodesis (fusion)

Always walk with a limp and shorter leg Success requires joints below and in front

of the ankle to be normal 100% arthritis rate at 20 years in other

joints Fusion rate 83% Average 17.5 weeks to solid fusion Residual discomfort 8-20% 2% amputation rate for salvage

Ankle Arthrodesis (fusion)

Malunion =poor position of fusion

Nonunion = failure of bones to fuse

Both will require another surgery to fix!!

Complications

IMPLANTS

Ankle Arthroplasty

Ankle Arthroplasty

Ankle Arthroplasty Wound may have trouble healing Infections are concern with all joint

replacements Will require antibiotics with any procedure

Parts may wear over time Good outcomes require surgeon skilled in

this procedure

Arthroplasty vs. ArthrodesisJOINT REPLACEMENT (STAR

ANKLE)1 FUSION Enables motion at the joint Provides predictable pain

relief (comparable to fusion) Can correct significant

deformities of the ankle Moderate ‘non-weight

bearing’ healing time (2-6 weeks)

6% revision rate @ 5 years2

May require device replacement (90% survivability of implant at 10 years)3

Locks ankle joint at fixed position

Provides predictable pain relief

Can correct significant deformities of the ankle

Prolonged ‘non-weight bearing’ healing time (2-4 months)

10% non-union rate4

May lead to arthritis in other joints of foot

DRIVING AFTER ANKLE/FOOT SURGERIES/INJURIES

The decision to drive after an orthopedic injury or surgery is fraught with legal and safety issues. Although driving is an important part of most patients lives, there are no well established guidelines for determining when it is safe to drive after injury or treatment.

Patients should not drive with a cast or brace on the right leg.

It can impair braking ability and reaction times.

QUESTIONS ???