Ankle Arthritis WORK RELATED

1. Ankle Arthritis WORK RELATED Dr. Alan G. Lewis Eastern Oklahoma Orthopedic Center MKT 16088 Rev B

2. What is Arthritis? • Latin for inflammation of a Joint • Arthros = joint • it is = inflammation • Arthritis – leading cause of disability in US • Several different types • All lead to destruction of the cartilage

3. Types of Ankle Arthritis • Osteoarthritis (OA) • “Wear and tear” • Slow and progressive loss of cartilage • Rheumatoid Arthritis • Immune system destroys cartilage • Often many joints attacked at the same time • Post-traumatic Arthritis • Often after injury to ankle (sprain or fracture) • Can occur months or years after an injury

4. What happens in arthritis? Normal Arthritis

5. What happens in arthritis? Normal Arthritis

6. What happens in arthritis? Normal Arthritis

7. What Causes my Pain? • Damaged and Flaking Cartilage • Can float in joint and get caught at times • Ankle feels unstable and locks at times • Bone on Bone Contact • Ankle makes a grinding noise at times • Swelling and Stiffness • Ligaments loosen and ankle feels unstable • Bone spurs or extra bone around joints • Loss of ankle motion • Spurs can hit each other causing severe pain episodes

8. What are my symptoms? • Pain • worse with prolonged exercise/activity • worse with first steps after resting • Stiffness • Morning stiffness the worst • Joint is stiffer/harder to move over time • Swelling by end of the day • Joint feels unstable at times and “gives out” • Episodes of severe pain and joint locking

9. X-ray changes in arthritis Normal Mild arthritis

10. X-ray changes in arthritis Moderate arthritis Severe arthritis

11. MRI changes in arthritis

12. Treatment Goals • Relieve pain/inflammation • Slow disease progression • Improve quality of life • Restore/maintain functional independence

13. Treatment Options • Medications • Lifestyle changes • Physical Therapy • Bracing • Surgery

14. Medications • Pain relievers (tramadol; opioids) • Non-steroidal anti-inflammatory drugs • COX-2 selective • Non-selective anti-inflammatories • Nutritional supplements • Glucosamine/chondroitin sulfate • Fish oil/vitamin E • Joint Injections • Cortisone • Hyaluronic acid? • Platelet rich plasma?

15. Medications

16. Lifestyle Changes • Avoidance of impact activities • Running, impact aerobics, treadmills • Non impact exercise • Swimming • Biking • Yoga • Cane or walker • Weight loss • Ankle sees 5X body weight

17. Physical Therapy • Improve ankle motion • Stretching routines • Improve ankle strength • Non impact exercises • Home exercise program • Decrease pain and swelling • Electrical stimulation • Heat and cold therapies • Massage

18. Brace Options • Shoe modifications • Inserts • Rocker soles • Non fixed supportive braces • Lace up ankle braces • Compression wraps • Fixed supportive braces • Posterior splints • Circumferential braces

19. Non fixed supportive braces Cloth lace up Plastic hinge

20. Fixed Supportive Braces Posterior splint Circumferential

21. Shoe modifications

22. Surgical Treatments • Arthroscopic Debridement • Early stages • Small incisions/camera used to clean joint • Arthrodesis (fusion) • Advanced arthritis • Fuse joint into single bone • Good outcomes, long recovery from surgery • Arthroplasty (Joint replacement) • Advanced arthritis • Replace joint with implant • Preserves joint motion, but implant may loosen or fail over time

23. Arthroscopic Debridement

24. Arthroscopic debridement

25. Arthroscopic debridement

26. Ankle Arthrodesis (fusion)

27. Ankle Arthrodesis (fusion)

28. Ankle Arthrodesis (fusion) • Always walk with a limp and shorter leg • Success requires joints below and in front of the ankle to be normal • 100% arthritis rate at 20 years in other joints • Fusion rate 83% • Average 17.5 weeks to solid fusion • Residual discomfort 8-20% • 2% amputation rate for salvage

29. Ankle Arthrodesis (fusion) Complications • Malunion =poor position of fusion • Nonunion = failure of bones to fuse Both will require another surgery to fix!!

30. IMPLANTS

31. Ankle Arthroplasty

32. Ankle Arthroplasty

33. Ankle Arthroplasty • Wound may have trouble healing • Infections are concern with all joint replacements • Will require antibiotics with any procedure • Parts may wear over time • Good outcomes require surgeon skilled in this procedure

34. Arthroplasty vs. Arthrodesis Joint Replacement (STAR Ankle)1 Fusion • Enables motion at the joint • Provides predictable pain relief (comparable to fusion) • Can correct significant deformities of the ankle • Moderate ‘non-weight bearing’ healing time (2-6 weeks) • 6% revision rate @ 5 years2 • May require device replacement (90% survivability of implant at 10 years)3 • Locks ankle joint at fixed position • Provides predictable pain relief • Can correct significant deformities of the ankle • Prolonged ‘non-weight bearing’ healing time (2-4 months) • 10% non-union rate4 • May lead to arthritis in other joints of foot

35. DRIVING AFTER ANKLE/FOOT SURGERIES/INJURIES • The decision to drive after an orthopedic injury or surgery is fraught with legal and safety issues. Although driving is an important part of most patients lives, there are no well established guidelines for determining when it is safe to drive after injury or treatment. • Patients should not drive with a cast or brace on the right leg. • It can impair braking ability and reaction times.

36. QUESTIONS ???