Surgery to Preserve the Arthritic Ankle

Surgery to Preserve the Arthritic Ankle

The management of ankle osteoarthritis (OA) in young adults is a challenge. The two most common treatment approaches are ankle fusion and total joint replacement. But a long life expectancy and high activity levels bring both of these options under question.

In this article, surgeons from Switzerland bring forward a third possible option: realignment surgery. This type of ankle reconstruction works best in young patients with a partially preserved joint surface.

In this study, the authors show how realigment surgery decreased pain and improved ankle range of motion. After taking X-rays and measuring all angles, the type of surgery needed was planned for each patient. As a result, patients had better walking ability and could do more in terms of general activity.

Osteotomy and soft tissue release and balancing were used to restore the joint space and leg length evenly. During an osteotomy, the surgeon removes a pie-shaped wedge of bone. The remaining bone is realigned toward a more neutral position.

There are different types of osteotomies. The surgeon assesses each patient to determine the best reconstruction surgery to perform. Realignment surgery puts the joints of the ankle back into place. This allows for more normal motion. Pain is decreased and walking ability is improved.

The follow-up was too short to report on long-term outcomes. There were some patients who needed a second surgery. All patients in this study will be followed further and a report published with results later.

Geert I. Pagenstert, MD, et al. Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis. In Clinical Orthopaedics and Related Research. September 2007. Vol. 462. Pp. 156-168.