Arthritis of the ankle joint can occur with a wide range of severity, and the more aggressive forms can destroy the joint. Debridement is opted for milder cases.
Surgical Debridement
If ankle arthritis is mild to moderate, surgical debridement may be performed to “clean out” bone fragments of cartilage from the joint. Bone spurs, or osteophytes, can develop in arthritic joints. When the joint degenerates, articular cartilage breaks down and bone rubs against bone, it forms bone spurs known as osteophytes. In addition to osteophytes, stray pieces of cartilage or soft tissue may also be removed from the ankle joint using either arthroscopically or conventional open surgery. The former is preferred if the debris is small in size.
Arthroscopic debridement requires a small incision through which a thin, flexible arthroscope (camera) is inserted into the joint space. Small instruments are used to remove debris from the joint. But if debris or osteophytes appear on x-ray imaging too big to be removed this way, an open procedure is performed instead. In either case, it is performed under general or spinal anesthesia.
The benefits of debridement include pain relief and improvement in range of motion. Most people can return home the same day but require crutches for 1-2 days and need to wear a splint for one or two weeks. The recovery time after ankle debridement depends on age and the choice of surgical approach.
Joint Fusion
If ankle arthritis is extremely painful and the pain is refractory to medication or a brace, the joint fusion may be needed. This process involves surgically fusing two joint bones permanently using metal screws and plates. The bones eventually fuse, rendering the joint immobile.
The metallics hardware may be eventually removed.
Joint fusion is also performed under general or spinal anesthesia.
Patients are not sent home the same day and pain control is required. Supportive splint and crutches are needed to avoid putting weight on the ankle. One typically needs to be on crutches and wear the boot for another three months.
Total Joint Replacement
If arthritis has caused significant damage to the ankle joint severely limiting one’s ability to perform daily activities, then total joint replacement is considered. In this procedure, bones of the ankle joint are replaced with durable plastic and metal hardware/prosthesis with a goal to restore function and eliminating the pain.
This procedure is also performed under general or spinal anesthesia. An incision is made above the ankle joint and the damaged bones and cartilage are removed and the hardware is placed. The patient has discharged a supportive splint that is to be worn for at least two weeks, although crutches may be used to avoid putting weight on the foot and ankle. 1-2 months of physical therapy is required to recover strength, flexibility, and range of motion.
