5 Surgeries For Ankle Arthritis

From debridement of cartilage to total joint replacement

Ankle arthritis is a condition in which the cartilage of the ankle joint deteriorates, causing pain and restricted movement. Progressive arthritis leads to bone cysts and bone spur formation. When conservative therapies—such as ankle braces, cushioned insoles, anti-inflammatory drugs, cortisone injections, and physical therapy—fail to restore mobility or provide pain relief, surgery may be necessary. Surgical options for ankle arthritis range from minimally invasive arthroscopic ("keyhole") procedures to total replacement of the ankle joint.

Ankle Debridement and Exostectomy

Ankle arthritis is characterized by the development of bone spurs (osteophytes), typically on the front of the joint. Over time, the spurs can become quite large and extend to the outside of the joint, where they can break off into loose, bony fragments. The cartilage surrounding the joint will also begin to roughen and deteriorate, causing pain and a significant reduction of movement.

Ankle debridement and exostectomy are two procedures used to "clean up" a joint to reduce pain and increase range of motion. Ankle debridement removes inflamed tissue in the joint space (synovium), smoothes out rough cartilage, and extracts loose bits of cartilage or bone. Exostectomy is the removal of osteophytes.

Both procedures are used to treat mild to moderate ankle arthritis. They're typically performed on an outpatient basis arthroscopically using narrow instruments and a flexible tube-like scope to access the ankle through a series of small incisions. If the damage is extensive or difficult to access, open surgery may be performed using a larger incision.

To prevent fractures in weakened areas of bone—particularly fluid-filled subchondral cysts inside the ankle joint—a bone marrow injection (using cells harvested from the patient) may be recommended.

Although debridement and exostectomy can provide significant relief, bone spurs can often reform over time. Secondary scar tissues can also develop and interfere with joint function. In such cases, additional surgery may be required.

Ankle Arthrodesis

Ankle arthrodesis, also known as tibiotalar arthrodesis or ankle fusion, is a surgical technique used when debridement is unable to provide stability or sustained pain relief. It involves fusing together the major bones of the lower leg (the tibia and fibula) with the talus bone of the ankle. The goal is to increase stability and eliminate painful bone-on-bone friction.

Depending on the severity of the condition, arthrodesis may be performed either arthroscopically or with an open incision. Either way, the surgeon will make an incision in the ankle and debride and compress the bones to correct misalignments. They will then permanently fix the bones with plates, nails, screws, or other hardware.

The downside to ankle fusion is that it significantly reduces ankle flexibility. This lack of flexibility can put significant strain on the knee and foot joints, making them more prone to arthritis in the future.

Cartilage Repair

For joint cartilage that has been severely diminished one of three types of cartilage repair may be considered.

  • Microfracture: This is the simplest option. After removing the damaged cartilage, tiny holes are made in the talus bone. Blood and cells will then trickle into the holes, forming blood clots. The clots will gradually turn into a type of scar tissue called fibrocartilage. The microfracture procedure can be performed arthroscopically on an outpatient basis.
  • BioCartilage: For extensive cartilage damage this powder, which is comprised of collagen, proteins, and growth factors, is mixed with stem cells harvested from a patient’s blood or bone marrow and transferred to tiny holes drilled in the talus bone.
  • Osteochondral graft: In this procedure, cylinders of cartilage harvested from the patient's knee (or a cadaver) are directly grafted onto the ankle bone. It is the most invasive of the three surgeries and often requires breaking a portion of bone to access the damaged area.

Osteochondral grafts are reserved for extremely large defects or when other cartilage repair efforts fail. 

Ankle Arthrodiastasis

Ankle arthrodiastasis is a surgical option for people with severe ankle arthritis who want to try to avoid ankle replacement. It involves stretching the ankle joint to increase the space between the talus and tibia bones and affixing an external fixation device to the talus and the tibia with metal pins and wires. This device is worn for approximately three months, during which time the ankle can bear the weight of standing or walking.

The goal of ankle arthrodiastasis is to provide damaged cartilage time and space to repair itself. Stem cells extracted from the person's body (usually the pelvis) can then be used to grow what is known as neo-cartilage.

While attractive to younger people who want to avoid more invasive procedures, ankle arthrodiastasis is effective in only around 50% of cases.

Ankle Arthroplasty

Ankle arthroplasty, also known as an ankle replacement surgery, involves the replacement of parts of the fibula, tibia, and talus bones with prosthetics. For this surgery, the top surface of the talus bone and the bottom surfaces of the tibia and fibula bones are removed and replaced with artificial components separated by a soft polyethylene pad. Modern prosthetics are composed of porous metallic materials stabilized with or without cement.

Although prosthetic designs have improved in recent decades, ankle replacement remains challenging because of the joint’s multidirectional physiology. Success rates tend to be lower than with knee and hip replacements.

There are pros and cons to ankle replacement. On the one hand, it offers a better range of motion and higher satisfaction among patients. On the other, ankle fusion is safer and more reliable, with half as many people needing additional surgery compared to arthroplasty.

Recovery from ankle replacement is lengthy and requires extensive physical therapy and rehabilitation. People who have this surgery are advised against high-impact activities such as running and jumping, although swimming, cycling, and hiking usually are safe.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hsu A, Gross CE, Lee S, Carreira DS. Extended indications for foot and ankle arthroscopy. J Am Acad Orthopaed Sur. 2014 Jan;22(1):10-9. doi:10.5435/JAAOS-22-01-10

  2. Ulici A, Balanescu R, Topor L, Barbu M. The modern treatment of the simple bone cysts. J Med Life. 2012;5(4):469-73.

  3. Yasui Y, Hannon CP, Seow D, Kennedy JG. Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop. 2016;7(11):700-8. doi:10.5312/wjo.v7.i11.700

  4. Medda S, Al'Khafaji IM, Scott AT. Ankle arthroscopy with microfracture for osteochondral defects of the talus. Arthrosc Tech. 2017;6(1):e167-74. doi:10.1016/j.eats.2016.09.013

  5. Fansa A, Drakos M, Cabe T, et al. Outcomes following the treatment of talar osteochondral lesions with BioCartilage and bone marrow aspirate concentrate mixture. Foot Ankle Orthop. 2018 Feb;2018:2473011418S00049. doi:10.1177/2473011418S00049

  6. Bisicchia S, Rosso F, Amendola A. Osteochondral allograft of the talus. Iowa Orthop J. 2014;34:30-7.

  7. Wynes J, Kaikis AC. Current advancements in ankle arthrodiastasis. Clin Podiatr Med Surg. 2018;35(4):467-79. doi:10.1016/j.cpm.2018.05.006

  8. Castagnini F, Pellegrini C, Perazzo L, Vannini F, Buda R. Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives. J Exp Orthop. 2016;3(1):3. doi:10.1186/s40634-016-0038-4

  9. Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V. Total ankle replacement. Dtsch Arztebl Int. 2015;112(11):177-84. doi:10.3238/arztebl.2015.0177

  10. Lawton CD, Butler BA, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res. 2017;12(1):76. doi:10.1186/s13018-017-0576-1