Total Ankle Arthroplasty in Rheumatoid Arthritis and Osteoarthritis

Final destruction of the upper ankle joint today is most commonly treated by the surgical procedures of ankle arthroplasty or fusion. Three patient groups are mainly affected: those with posttraumatic, osteoarthritic and rheumatic diseases. There are considerable differences between the pathophysiological pathways of degenerative versus immunologically triggered, chronic inflammation-induced affections of the rheumatic illnesses. The latter underlie specific local, regional and systemic circumstances in the context of the differential indication and the entire perioperative management, which must be borne in mind to best treat the patients and avoid complications. Rheumatic patients exhibit immunologically induced co-morbidities and need very special anti-inflammatory medical treatment with important consequences for surgical and orthopaedic rheumatologic interventions. Initial measures include the whole spectrum of conservative procedures; later on, rheumatically induced synovitis of the upper ankle joint can be treated by arthroscopic synovectomy followed by radiosynoviorthesis six weeks later. The technically demanding procedure of arthroplasty of the upper ankle joint has regained popularity for quite some time, although many foots surgeons still prefer the fusion of this joint in end-grade destruction. In Germany, about 2000 ankle arthroplasty procedures are carried out each year with modern three-component endoprostheses, which lead to good mid-term results. Patients with rheumatic diseases, in particular, seem to benefit from this operation in the longer run. Both procedures (arthroplasty and fusion) have specific advantages and disadvantages as well as complication patterns. The indication is to be made on a case-by-case basis. Specialists in foot surgery and orthopaedics can be found via the websites of the relevant medical societies.