Dr. Alan G. Lewis Eastern Oklahoma Orthopedic Center MKT Rev B

 Latin for inflammation of a Joint  Arthros = joint  it is = inflammation  Arthritis – leading cause of disability in US  Several different types  All lead to destruction of the cartilage

 Osteoarthritis (OA)  “Wear and tear”  Slow and progressive loss of cartilage  Rheumatoid Arthritis  Immune system destroys cartilage  Often many joints attacked at the same time  Post-traumatic Arthritis  Often after injury to ankle (sprain or fracture)  Can occur months or years after an injury

NormalArthritis

NormalArthritis

Normal Arthritis

 Damaged and Flaking Cartilage  Can float in joint and get caught at times  Ankle feels unstable and locks at times  Bone on Bone Contact  Ankle makes a grinding noise at times  Swelling and Stiffness  Ligaments loosen and ankle feels unstable  Bone spurs or extra bone around joints  Loss of ankle motion  Spurs can hit each other causing severe pain episodes

 Pain  worse with prolonged exercise/activity  worse with first steps after resting  Stiffness  Morning stiffness the worst  Joint is stiffer/harder to move over time  Swelling by end of the day  Joint feels unstable at times and “gives out”  Episodes of severe pain and joint locking

NormalMild arthritis

Severe arthritisModerate arthritis

 Relieve pain/inflammation  Slow disease progression  Improve quality of life  Restore/maintain functional independence

 Medications  Lifestyle changes  Physical Therapy  Bracing  Surgery

 Pain relievers (tramadol; opioids)  Non-steroidal anti-inflammatory drugs  COX-2 selective  Non-selective anti-inflammatories  Nutritional supplements  Glucosamine/chondroitin sulfate  Fish oil/vitamin E  Joint Injections  Cortisone  Hyaluronic acid?  Platelet rich plasma?

 Avoidance of impact activities  Running, impact aerobics, treadmills  Non impact exercise  Swimming  Biking  Yoga  Cane or walker  Weight loss  Ankle sees 5X body weight

 Improve ankle motion  Stretching routines  Improve ankle strength  Non impact exercises  Home exercise program  Decrease pain and swelling  Electrical stimulation  Heat and cold therapies  Massage

 Shoe modifications  Inserts  Rocker soles  Non fixed supportive braces  Lace up ankle braces  Compression wraps  Fixed supportive braces  Posterior splints  Circumferential braces

Cloth lace upPlastic hinge

Posterior splint Circumferential

Arthroscopic Debridement – Early stages – Small incisions/camera used to clean joint Arthrodesis (fusion) – Advanced arthritis – Fuse joint into single bone – Good outcomes, long recovery from surgery Arthroplasty (Joint replacement) – Advanced arthritis – Replace joint with implant – Preserves joint motion, but implant may loosen or fail over time

 Always walk with a limp and shorter leg  Success requires joints below and in front of the ankle to be normal  100% arthritis rate at 20 years in other joints  Fusion rate 83%  Average 17.5 weeks to solid fusion  Residual discomfort 8-20%  2% amputation rate for salvage

 Malunion =poor position of fusion  Nonunion = failure of bones to fuse Both will require another surgery to fix!! Complications

 Wound may have trouble healing  Infections are concern with all joint replacements  Will require antibiotics with any procedure  Parts may wear over time  Good outcomes require surgeon skilled in this procedure

JOINT REPLACEMENT (STAR ANKLE) 1 FUSION  Enables motion at the joint  Provides predictable pain relief (comparable to fusion)  Can correct significant deformities of the ankle  Moderate ‘non-weight bearing’ healing time (2-6 weeks)  6% revision 5 years 2  May require device replacement (90% survivability of implant at 10 years) 3  Locks ankle joint at fixed position  Provides predictable pain relief  Can correct significant deformities of the ankle  Prolonged ‘non-weight bearing’ healing time (2-4 months)  10% non-union rate 4  May lead to arthritis in other joints of foot

 The decision to drive after an orthopedic injury or surgery is fraught with legal and safety issues. Although driving is an important part of most patients lives, there are no well established guidelines for determining when it is safe to drive after injury or treatment.  Patients should not drive with a cast or brace on the right leg.  It can impair braking ability and reaction times.