Posttraumatic Ankle Arthritis: An Update on Conservative and Surgical Management

Gary W. Stewart, Stephen F. Conti, RobRoy L. Martin

DOI: 10.2519/jospt.2007.2404

The purpose of this manuscript is to provide current information regarding the examination, conservative treatment, and surgical treatment for individuals with posttraumatic arthritis. Although inflammatory and osteoarthritis can occur, post­traumatic arthritis is the most common form of arthritis to affect the ankle. Posttraumatic ankle arthritis occurs in a generally younger, active population. It is characterized radiographically by an asymmetrical degenerative process and may be associated with a history of trauma, instability, and/or lower extremity malalignment.

When choos­ing between conservative/nonoperative versus surgical intervention, the extent of subchondral bone exposed and the time over which the arthritis has developed are factors that should be consid­ered. The role and effectiveness of conservative treatment, such as medication, patient education, shoe modification, bracing, stretching, mobiliza­tion, strengthening, and symptom management, need to be further determined. Surgical proce­dures for posttraumatic ankle arthritis can include distraction arthroplasty, arthrodesis, or total ankle arthroplasty.

Unlike the relatively new procedure of distraction arthroplasty, the outcomes for arthrod­esis have been well defined. Arthrodesis generally has a good outcome, but its limitations have been recognized. These limitations include the extended time required to achieve fusion, potential for non­union, arthritis developing in adjacent joints, leg length discrepancy, malalignment, chronic edema, symptoms due to the hardware, stress fractures, and continued pain. While first generation total an­kle arthroplasty led to poor results, advancements in prosthetic design and surgical technique have revived optimism regarding total ankle arthroplasty as an alternative to arthrodesis. The key for the fu­ture of total ankle arthroplasty may not be related to the development of newer ankle components but rather in refining the criteria to determine who would best benefit from joint replacement versus fusion.

J Orthop Sports Phys Ther. 2007;37(5):253-259. doi:10.2519/jospt.2007.2404

KEY WORDS: arthrodesis, arthroplasty, joint fusion, joint replacement

The extent of subchondral bone exposed and the time over which the arthritis has developed are factors that should be considered when choosing between conservative/nonoperative and surgical intervention.

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