Traumatology Team
- Chien-Shun Wang, Asst.Prof.
- Chao-Ching Chiang, M.D., Prof.
- Chun-Cheng Lin, Ph.D., Asst.Prof.
- Ming-Fai Cheng
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Ankle osteoarthritis
- Feature Summary
There are variety of treatments for ankle osteoarthritis including supramalleolar osteotomy, distraction arthroplasty, ankle joint fusion and total ankle arthroplasty. Each one of them has different indications. Patients in Taipei Veterans General Hospital would receive a thorough evaluation such as joint alignment, degrees of joint degeneration, joint stability and range of motion. Optimal treatments can thus be determined after complete assessment to reach optimal clinical outcomes.
- Overview
Supramalleolar osteotomy should been considered in ankle osteoarthritis patients with uneven joint wearing. In relatively young patient with painful arthritis, distraction arthroplasty can relief the osteoarthritis symptoms and preserve the joints. In elderly patients having painful ankle arthritis with severe valgus or varus deformity, ankle fusion is a relatively safe treatment choice with lower complication rate. As for total ankle arthroplasty, although it has been reported with good clinical results and promised longevity, the treatment option should be preserved for elder ankle osteoarthritis patients with relative good alignment.
- Features
Supramalleolar osteotomy: indicates ankle alignment correction. Through alignment correction, ankle joint stress can be redistributed and shifted to the relatively healthy part of the joint. Decreased wearing and relived symptoms are the main impact of this procedure.
Distraction arthroplasty: indicates a gradual distraction force applied to the ankle joint that loosens the peri-articular soft tissue for decreasing the ankle joint wearing during weight bearing.
Ankle joint fusion: means to fuse the damaged ankle joint. Through fusion, bone erosion is prevented during activities and arthritic symptoms are thus relieved.
Total ankle arthroplasty: indicates resurfacing the ankle joint with artificial joint. Through this procedure, bone erosion is prevented and symptoms of arthritis are thus relieved.
- Procedure
Supramalleolar osteotomy: could be done with minimally invasive technique with several small wounds over the medial or bilateral aspect of the ankle joint. This procedure involves tibial osteotomy with or without bone graft interposition to change the alignment of the operated limb. Since the impact of this procedure relies on bony alignment correction, patients who received this procedure will need weeks of activity limitation after the operation until bone union.
Distraction arthroplasty: Most of the time, the distraction force was given through external fixator. Patients who received this procedure will have an external fixator applied on his/her ankle for weeks.
Ankle joint fusion: This procedure can be done minimal invasively or arthroscopically at Taipei Veterans General Hospital. After joint surface preparing with subchondral bone exposure, tibia would be fused with talus. The success of this procedure relied on successful bone union. Weeks of activity limitation with splint fixation is needed after the operation.
Total ankle arthroplasty: This procedure involves precise bone cutting and resurfacing of the tibia and talus joint surface. Since ankle joint is relative small in size with few soft tissue around, patient who receive total ankle arthroplasty should receive 2-4 weeks of splint protection until good soft tissue recovery and bone-implant integration.
- Caution
Other than general surgical complications, specific side effect or complications for each procedure were listed below:
Supramalleolar osteotomy: Since this procedure does not resurface the worn joint surface, osteoarthritic symptoms would not disappear after this procedure. However, improvement of pain, alignment, and increased live span of native joint are expected after the surgery.
Distraction arthroplasty: Same as supramalleolar osteotomy, worn cartilage would not be resurfaced during this procedure. Symptoms might persist or even progress after this procedure.
Ankle joint fusion: This procedure is expected to relief most of the osteoarthritis symptoms. However, lack of ankle joint range of motion is the man impact, and patient might have some limitation during squatting, climbing or down stairs, or other activities that involve ankle joint motion.
Total ankle arthroplasty: The durability of current artificial ankle joint is about 15-20 years. Secondary surgery might be needed after wearing of the artificial liner or loosening of the artificial components before or after this period.
- Estimate Cost
Supramalleolar osteotomy, distraction arthroplasty and ankle joint fusion may cost from 100,000 to 200,000 NTD. Total ankle arthroplasty may cost up to 500,000 NTD.
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