Ankle OA

AetiologyAnkle OA

 

Trauma

 

A. Ankle Fracture
 

Types

- Weber A 4%
- Weber C 33%
- Displaced large posterior malleolar

 

Any OA develops in first 2 years

 

Causes

- articular damage at time of injury
- non anatomical reconstruction
- complications i.e. infection

 

B. Plafond Fracture

 

C. Talus Injury

 

Talar Dome OCD

Talus AVN

Talar neck malunion

 

Other

 

Inflammatory OA

Infection

Hemochromatosis

Hemophilia

Charcot

 

Incidence

 

Ankle OA much lower than hip or knee

 

Anatomy

 

Thin cartilage 1 mm

 

Joint highly congruent

 

Tibio-talar contact stresses
- 1mm shift causes 40% decrease in contact area
- medial instability more important than lateral instability

 

Clinically

 

Pain

- with weight bearing

- nightime

 

Stiff Ankle Joint

 

Xray

 

Ranges from

- anterior spurring

- severe OA

 

Ankle Xray Anterior Tibial OsteophyteAnkle OA Kissing Spurs

 

Ankle OA AP XrayAnkle OA Lateral Xray

 

CT

 

Useful to define small anterior osteophytes

- may be causing pain with excessive dorsiflexion

 

Ankle CT Anterior Osteophyte

 

MRI

 

Ankle OA MRI

 

Ankle OA Coronal MRIAnkle OA Sagittal MRI

 

Management

 

Non Operative

 

Solid Ankle Foot Cushion (SACH) + rocker bottom sole

Analgesia

HCLA / Hyaluronic acid Injections

 

Operative Options

 

1.  Arthroscopic debridement

 

Technique 1

- debride chondral lesions
- microfracture / abrasion

 

Ankle Scope Medial OA

 

Technique 2

- removing kissing osteophytes

- anterior tibial and talar neck osteophytes

 

Ankle Spurs with Anterior ImpingementAnkle Scope Anterior Tibial OsteophyteAnkle Scope Osteophyte Debridement

 

2. Articular distraction with external fixator

 

Technique

- apply for 4/12
- distracted 5 mm
- reasonable results reported
- up to 3 years improvement
- delays arthrodesis

 

3.  Ankle Arthrodesis

 

4.  Ankle Replacement