New surgical procedure repairs arthritic ankle damage

August 26, 2017

The new ankle procedure was first reported in France and involves an external-fixation procedure that applies tension to expand the joint and leave room for new cartilage to form, thereby eliminating painful bone-on-bone pressure, according to ACFAS President-elect James L. Thomas, DPM, FACFAS, a foot and ankle surgeon practicing at the University of Alabama Birmingham. "This is an exciting new approach for treating chronic ankle arthritis," said Thomas.

In an oral presentation at the American College of Foot and Ankle Surgeons Annual Scientific Conference, Brad Lamm, DPM, AACFAS, a foot and ankle surgeon affiliated with Sinai Hospital in Baltimore, reported that ankle-joint distraction with external fixation for treatment of ankle arthritis is starting to gain acceptance among foot and ankle surgeons in the US, although its use has been limited.

"Most patients with ankle arthritis want to preserve a functioning joint and are looking for alternatives to ankle-fusion procedures and joint replacements to relieve their pain," said Lamm. "While fusion surgery has been a mainstay for many years and works very well for pain relief, fusing the ankle joint makes it immobile and permanently stiff. Ankle joint distraction with external fixation preserves the joint, eliminates pain and increases function," he explained.

Though new for treating ankle arthritis, minimally invasive, external- fixation techniques are widely used by foot and ankle surgeons to repair fractures. Bones are immobilized with pins, screws or wires, which are secured outside the skin with clamps and rods that form an external frame.

For treating ankle arthritis, wires inserted through the skin are attached to the frame, and the resulting tension pulls apart the ankle joint, creating space for new cartilage to replace what was destroyed by arthritis. Prior to applying the fixators, the foot and ankle surgeon may perform ankle arthroscopy to clean out arthritic tissue and bone spurs.

Most external-fixation surgeries are performed in less than three hours and the risk of infection is minimal. The patient can walk with the frame in place the day after surgery and the fixators remain in place for about four months until new cartilage is in place.

Thomas noted that even though the initial experiences with external fixation for chronic ankle arthritis have been encouraging, more long-term studies are needed before the procedure becomes a mainstream treatment for these patients.