Conservative Treatment of Ankle Osteoarthritis

Abstract

Despite the disabling nature of ankle osteoarthritis (OA), there is poor scientific evidence for a conservative treatment compared to the hip and knee OA. In this regard, most of the treatment options in use are not based on clinical studies of the ankle, and they are extracted from evidence obtained from clinical studies of other lower limb joints. However, this does not seem to be a good idea, since the aetiology of ankle OA is quite different from that of the hip or knee. Nonpharmacological and pharmacological treatments such as nonsteroidal anti-inflammatory drugs, hyaluronic acid, corticosteroid, platelet-rich plasma injection and mesenchymal stem cells injections have been reported. However, further research is required in this field to obtain a specific clinical practice guideline for the conservative treatment of ankle OA.

Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

“…After retrospective review, 319 ankles from 312 patients met inclusion criteria. Inclusion criteria were failure of a minimum of 3 months of non-operative treatment [ 5 ], tibiotalar arthritis (Takakura Stage 2, 3 or 4) [ 39 ], and a minimum of 6 months follow-up ( Figure 1 and Figure 2 ). Exclusion criteria were previous hindfoot surgery, arthroscopic tibiotalar arthrodesis, active septic arthritis, or age < 18-years-old.…”

“…The posttraumatic etiology is the most common etiology of the end-stage ankle osteoarthritis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. After failure of nonoperative treatments for severe ankle arthritis [ 5 ] including bracing/immobilization, anti-inflammatories, shoe wear and activity modification, and corticosteroid injections, patients have two operative options—arthroplasty [ 8 , 9 , 10 , 11 , 12 ] and arthrodesis [ 13 , 14 , 15 , 16 , 17 , 18 ]. Tibiotalar arthrodesis still remains the current gold standard [ 19 ].…”

Does Demineralized Bone Matrix Affect the Nonunion Rate in Arthroscopic Ankle Arthrodesis?

“…For this study, 516 consecutive patients underwent ankle arthrodesis between March 2002 and May 2016, among whom 58 ankles from 56 patients who underwent primary arthroscopic ankle arthrodesis were included in this study. The inclusion criteria were severe tibiotalar arthritis (Takakura stage 2, 3, or 4) [23], failure of a minimum of three months of nonoperative treatment [4], ≥18 years of age, and a minimum of six months of radiographic follow-up [24]. All patients were treated by one of four fellowship-trained orthopedic foot and ankle surgeons.…”

“…Ankle osteoarthritis is most commonly caused by previous trauma [1][2][3][4][5][6] and can result in significant pain and disability [7,8]. Nonoperative treatments, including activity modification, physical therapy, anti-inflammatories, shoe inserts/modifications, ankle braces, and tibiotalar joint corticosteroid injections, frequently do not provide lasting relief [4,9,10]. Thus, tibiotalar fusion is an established treatment option for patients suffering from end-stage arthritis.…”

“…Thus, tibiotalar fusion is an established treatment option for patients suffering from end-stage arthritis. Open ankle arthrodesis has become the gold standard in operative treatment as it reliably alleviates joint pain and is able to correct deformities [4]. More recently, arthroscopic ankle arthrodesis has seen an increase in adoption as it avoids the morbidity associated with open procedures [11].…”