Posttraumatic ankle arthritis: an update on conservative and surgical management

This manuscript offers current information regarding the examination, conservative treatment, and surgical treatment for individuals with posttraumatic arthritis. Although inflammatory and osteoarthritis can occur, posttraumatic arthritis is the most common form of arthritis to affect the ankle. Posttraumatic ankle arthritis occurs in a generally younger, active population. It is radiographically characterized by an asymmetrical degenerative process and may be associated with a history of trauma, instability, and/or lower extremity malalignment. When choosing between conservative/nonoperative versus surgical intervention, the extent of subchondral bone exposed and the time over which the arthritis has developed are factors that should be considered. The role and effectiveness for conservative treatment, such as medication, patient education, shoe modification, bracing, stretching, mobilization, strengthening, and symptom management, needs to be further determined. Surgical procedures for posttraumatic ankle arthritis can include distraction arthroplasty, arthrodesis, or total ankle arthroplasty. Unlike the relatively new procedure of distraction arthroplasty, the outcomes for arthrodesis have been well defined. Arthrodesis generally has a good outcome, but its limitations have been recognized. These limitations include the extended time required to achieve fusion, potential for nonunion, arthritis developing in adjacent joints, leg length discrepancy, malalignment, chronic edema, symptoms due to the hardware, stress fractures, and continued pain. While first generation total ankle arthroplasty led to poor results, advancements in prosthetic design and surgical technique have revived optimism regarding total ankle arthroplasty as an alternative to arthrodesis. The key for the future of total ankle arthroplasty may not be related to the development of newer ankle components but rather in refining the criteria to determine who would best benefit from joint replacement versus fusion.