Ankle Joint Arthritis - Diseases of the Ankle Joint - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Ankle Joint Arthritis

Ankle joint arthritis involves a progressive wear and tear of the joint. Through intensive usage and the resulting accompanying wear and tear, or through an accident, the cartilage surface can be increasingly serrated and thinned out. Through this, the sliding ability of the joint can be impaired, and pain and recurring joint effusions can occur. Later, a loss of function of the affected joint can also occur.

In advanced stages the joint cartilage can be completely absent, so that unstable contact between the two joint surfaces of the bone develops. Conventional radiography of the ankle joint generally provides an indication of the advancement of the disease. In order to estimate the present damage prior to a possible intervention, an MRI scan must however be undertaken.

Therapy

The goal of the therapy for ankle joint arthritis lies in the restoration of pain-free weight-bearing and the improvement of function. As long as no profound damage to the joint cartilage is present, conservative methods are promising. These include, on the one hand, physiotherapeutic methods for the mobilisation of the ankle joint, as well as de-blocking methods, and also intra-articular applications of anti-inflammatory and cartilage synthesising substances. The muscular stabilisation of the ankle joint must not be forgotten, in order to minimise micro-rotating movements and thus reduce joint abrasion.

For the presence of profound cartilage damage which reaches the bone, the therapy of choice depends on the extent of the cartilage defect and the situation and stability of the surrounding cartilage. For smaller defects in the cartilage, the possibility exists to bore the affected area using a joint endoscopy (arthroscopy) with a minimally invasive procedure and to therefore stimulate the formation of new cartilage tissue. For bigger, interrelated defects a cartilage cell transfer can be undertaken if necessary.

If the wear and tear is too far advanced however, this method does not come into consideration. The freedom of pain can only now be achieved by a replacement of the ankle joint. The artificial ankle joint replacement (ankle prosthesis) is increasingly used and demonstrates good functional results. If it is the case that the joint situation is insufficient for this purpose, the freedom of pain can frequently be only brought about by undertaking operative joint stiffening (arthrodesis).

Aftercare

The aftercare of the operative ankle joint arthritis varies greatly depending on the therapy which has been undertaken. A three day partial weight-bearing on under-arm crutches is sufficient in cases of cartilage smoothening. For cartilage transplantation, a 6-week sole contact is required.

Ability to work

The recommencement of light office work can occur after 1 to 2 weeks, so long as under-arm crutches can be used.

Ability to do sport

For cartilage intervention operations with boring of the bone or cartilage cell transplantation, running and jumping sport types should be avoided for three months post-operatively, so that competition training can be recommenced at the earliest after 12 weeks.