Ankle arthritis: Review and current concepts

The ankle joint bears a very high load per unit of surface area. It has thinner cartilage as compared to hip or knee. If the surface area of the joint is decreased or the congruency is lost, then the pressures rise quickly, leading to arthritis. This is the reason for trauma being the most frequent etiological factor for ankle arthritis.Steroid injections can provide short-term relief. The role of intra-articular hyaluronic acid is controversial. Ankle arthroscopy is useful in early arthritis but is not effective in severe arthritis. Supramalleolar osteotomies have gained increasing popularity for the treatment of early and mid stage arthritis associated with varus or valgus deformity of ankle. Distraction ankle arthroplasty might be a treatment option for young patients though currently there is not much evidence to support its role.Ankle arthrodesis results in significant improvements in terms of pain and function and has been considered the gold standard for the surgical treatment of end stage ankle arthritis. In the last few years, arthroscopic ankle arthrodesis has gained increasing popularity, with reports of shorter hospital stays, shorter time to solid fusion, and equivalent union rates when compared with open arthrodesis. Ankle replacement has gained popularity in the last 15 years. The advantages of this surgery include: preserved movements, less stress on other joints and improved gait. The current third generation implants have resulted in improved outcome and better survivorship. However, the results of ankle replacement are still inferior to hip and knee replacement. The reported ten-year survivorship of ankle replacement ranges from 69 to 84%.