ankle rheumatoid arthritis

Total Ankle Replacement for Rheumatoid Arthritis?

Is total ankle replacement surgery an option if the pain in my knee is caused by rheumatoid arthritis?

How do you react when a friend or family member tells you that they have been diagnosed with arthritis? No doubt you are sympathetic, but doesn’t this sort of announcement seems fairly commonplace, even expected, if they are of a certain age?

Arthritis is a painful and potentially disabling disease and not something to be dismissive about, but it is true that it has become increasingly prevalent. In fact, more than a quarter of the adults in the U.S., nearly 55 million, have been officially diagnosed with arthritis. It is also believed that that number represents a significant underestimation of people who are actually affected. According to the Arthritis Foundation, “Based on adjusted estimates, 92.1 million adults either have doctor-diagnosed arthritis and/or report joint symptoms consistent with a diagnosis of arthritis.”

For those who are 65 or over, the numbers get even worse: half of all men and two-thirds of all women over 65 are believed to have arthritis. 

While having any type of arthritis is a reason for concern and usually includes pain, swelling, and some degree of stiffness and reduced function, the diagnosis that no one wants to hear is that of rheumatoid arthritis (RA).  Also painful and inflammatory, RA evokes a far more serious reaction because it is an autoimmune disease, which means that the body is waging war on itself. 

Researchers are still trying to discover exactly why the body’s immune system is sometimes activated inappropriately. What they do know is that it can have very serious consequences. Rheumatoid arthritis can not only produce pain, swelling, stiffness, and issues with mobility, in time it can lead to bone loss and even deformity. 

The one small and somewhat bright spot to RA is that it is far less common than other types of arthritis, like osteoarthritis and post-traumatic arthritis. Only around 1% of the population is affected by RA. 

Rheumatoid Arthritis in the Ankles

Rheumatoid arthritis can affect organs and tissue throughout the body, but the most common places for it to take hold is in the joints, especially the ankle joints. If you are diagnosed with RA, there is a 90% probability that symptoms will develop in the ankles. One of the first signs may be difficulty navigating stairs and any sort of incline. This will likely progress to the point where simply walking or even just standing will be painful.   

Besides being particularly aggressive, rheumatoid arthritis differs from other types in that it is a symmetrical condition, meaning that it affects both sides of the body at the same time. If you have RA in the left ankle, you will almost always also have it in the right one. This makes having it in a weight-bearing joint like the ankles even more problematic and has the potential to quickly become a serious quality of life condition. 

Treatment for RA often involves a team of healthcare professionals, which may include not only orthopedic surgeons but also rheumatologists, physical therapists, and rehabilitation specialists. A variety of nonsurgical treatments are available and may provide some pain relief while the rheumatologist works to stop or slow down the immune system response. 

Surgery may be recommended if there is excessive damage to the ankle joint and nonsurgical methods were not successful. The main options are joint fusion and joint replacement. While fusion can decrease the pain, it does result in loss of motion. Total ankle joint replacement surgery does not guarantee restoration of full function but most patients do experience significant improvement. Ankle replacement surgery has a high success rate and many of the replacement joints are lasting 15 years or longer. 

If you have questions about arthritis or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Passaic County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.

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