Treatment of osteoarthritis

Ankle osteoarthritis and quality of life

Many studies on quality of life in osteoarthritis show a strikingly negative effect on patients' general health. Joint degeneration often brings to mind older people using forearm crutches and daily painkillers, who struggle with simple tasks such as putting on shoes. Excessive medication use and reduced activity can contribute to gastrointestinal, heart and lung conditions. Patients with ankle osteoarthritis face similar problems but are usually younger, under 50. Having been very active until recently, they experience the effects of ankle osteoarthritis particularly intensely. Depressive disorders are not uncommon.

Unlike hip and knee osteoarthritis, ankle osteoarthritis more often develops after trauma. It can follow fractures or dislocations caused by road accidents, falls from height, skiing or skateboarding falls. Previous ankle sprains also play a role. The ankle carries the body's weight through stable movement, made possible by an efficient ligament system. These ligaments can be damaged to varying degrees during a sprain. Missed or improperly treated injuries lead to chronic instability and local cartilage damage, which in turn cause degenerative changes that may require ankle replacement. Diagnosis and treatment of ankle sprainsPatients with rheumatoid arthritis form a particular group who may need ankle replacement. This is a chronic, progressive systemic connective tissue disease of unknown cause, mainly affecting the joints of the hands and feet symmetrically, though larger joints, including the ankles, may also be involved. Unlike osteoarthritis, it affects younger people; see the linked article. When the ankle is affected, pain, swelling and redness initially appear. Excessive proliferation of synovial tissue causes destruction of cartilage, the joint capsule and ligaments. This irreversible process can rapidly destroy the joint surfaces. Until recently, ankle fusion, or arthrodesis, was the recommended operation. Ankle replacement now offers a better solution.

Modern design

Ankle replacements yesterday and today

The history of ankle replacement dates back to 1970, when a cemented two-component ankle prosthesis was first implanted. Early designs resembled hip implants and did not closely match the anatomy of the tibia and talus forming the ankle. Numerous early complications did not discourage researchers from improving the designs, and better solutions followed. The breakthrough came with three-component prostheses, in which a cushion or meniscus-like component sits between implants replacing the damaged joint surfaces. This extra component may be fixed to one implant or remain mobile during ankle flexion and extension.

Today's ankle implants reproduce healthy joint surfaces very precisely. The prosthetic components have a special titanium-alloy coating using trabecular metal technology, which, unlike earlier designs, does not require bone cement for fixation. This coating encourages adjacent bone to grow into it and stabilise the prosthesis. A lateral surgical approach improves wound healing, and a specialised frame allows very precise implant placement.

Return to full activity

Why choose an ankle replacement?

An ankle replacement preserves movement, which is important for normal walking. Before ankle replacements, joint fusion was the only effective treatment for advanced destructive changes. It limited daily activities and negatively affected quality of life. Fusion is still performed in selected cases but is increasingly replaced by more anatomical solutions such as joint prostheses.

Ankle replacement surgery at our hospital

Our hospital offers services and expertise in treating foot, ankle and knee conditions. It has operated since 2005, and we have performed over 20,000 operations since then. Initially, Halluxmed primarily specialised in forefoot deformities, including hallux valgus, or bunions, hallux rigidus and hammer toes. The hospital name originated at that time and no longer fully reflects the broad range of services we provide.

Patients can have imaging on site, including the distinctive standing CT examination, PedCAT, ultrasound and pedobarography. The hospital has two modern operating theatres and an orthopaedic ward where patients stay for three days after surgery. The operation uses spinal anaesthesia. Anaesthetists minimise postoperative pain with ultrasound-guided nerve blocks. Everything is planned to optimise care for patients with ankle conditions. The medical, orthopaedic and anaesthesia teams, nurses, administrative staff and support services work together as one unit, making every procedure and task smooth, consistent and efficient. This is a clear advantage of our specialised focus.

Movement instead of fusion

What happens after surgery?

Patients usually spend three days in hospital after surgery. For the first two weeks they use forearm crutches and a lightweight synthetic cast without bearing weight on the operated limb. At the first follow-up visit after two weeks, the sutures and cast are removed. For the next four weeks, patients use a walker boot and forearm crutches with partial weight-bearing. For a further four weeks, they use the walker boot without crutches and with full weight-bearing; during this period the brace is removed at night and for exercises. After ten weeks, walking without orthopaedic aids is possible. Hip and knee movements and isometric exercises for the operated limb begin in the first days. Assisted passive exercises to restore movement begin after three weeks. Active ankle exercises begin after six weeks, and muscle strengthening after ten weeks. This protocol may change according to the clinical situation, bone quality, accompanying deformities and other factors.