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Artificial ankle joint

The ankle joint – It is the most frequently injured large joint of the lower extremity, bears the greatest load per unit area and has the thinnest cartilage. Nevertheless, osteoarthritis (wear and tear) is less common here than in the knee or hip joint, as the cartilage cover is more resilient and resistant. If ankle arthrosis does occur, it can lead to severe pain and restrict mobility. An ankle joint prosthesis helps to maintain the mobility of the joint.

Causes of ankle joint wear and tear

The most common causes of ankle wear are post-traumatic conditions and rheumatism. There are also other factors that can promote wear and tear of the ankle joint. These include obesity, repeated overloading of the joint through certain sports or activities, age-related changes in the joint cartilage and genetic predisposition.

Depending on the progression of the disease, pain in the foot, swelling, redness and even joint stiffness may occur. Prompt treatment by a doctor is necessary to avoid consequential damage.

Treatment of wear and tear

If the wear and tear of the ankle joint is not yet so advanced, conservative treatment options are initially used to alleviate the symptoms and improve the function of the joint. Non-surgical treatment includes analgesics and anti-inflammatory drugs, activity modifications, physiotherapy, orthoses (braces) and intra-articular injections.

Operational options

If the wear is already severe and the patient has significant problems, surgical treatment is the next step after conservative therapy has been exhausted.

Nailing of the defective ankle joint
Stiffening of the ankle joint

1. stiffening

Surgical treatment of osteoarthritis of the upper ankle joint in the final stage is traditionally carried out by arthrodesis (“fusion”, “screwing”), which is performed by fusing the affected joints to prevent movement between the bones and thus eliminate the wear and tear. Although the patient is usually pain-free afterwards , the ankle joint loses mobility. This can severely restrict the patient’s quality of life.

2. ankle joint prosthesis

Ankle replacement (total ankle arthroplasty) is nowadays a very good alternative to arthrodesis. Minimally invasive, possibly arthroscopically assisted ankle joint strengthening has recently become increasingly popular. Joint replacement with an endoprosthesis offers the advantage of preserving the mobility and function of the joint. This can also lead to an improvement in gait, including a reduction in limping, and protection of other joints.

The likelihood of a follow-up operation after an artificial joint is just as high as after a hardening of the ankle joint. The main disadvantage of hardening the ankle joint is the restriction of movement in the joint and thus the overloading of the ankle joints with every step, which over the years leads to wear and tear and the development of pain.

Development of the prosthesis

The first ankle joint endoprosthesis was performed by Lord and Marrotte in 1970. These were artificial joints of the first generation, which were characterized by a high complication rate. In the 1980s, second-generation endoprostheses came to the fore, the results of which were already significantly better, but still lagged behind the results of hip or knee replacements. Only the third generation of artificial joints developed in the 1990s achieved very good results and are still implanted today. They consist of three parts, are cement-free and perfectly anatomically shaped.

Patient expectations

Modern artificial ankle implants meet patients’ expectations, as the latest studies using specific evaluation systems (MODEMS expectations scale) show. Patients’ expectations (not least due to the influence of the Internet) are constantly rising and are higher before artificial joint surgery than before joint strengthening (arthrodesis). After the operation, there is a significant reduction in pain, which enables an increase in physical activity both at work and during leisure time, as well as an improvement in the quality of sleep. According to these studies, patients are more satisfied after an artificial joint than after an ankle arthrodesis.

Total ankle joint endoprosthesis
Total ankle joint endoprosthesis

Optimal preparation for successful ankle endoprostheses

However, a prerequisite for a good result after the endoprosthesis is a detailed knowledge of the anatomy of the ankle joint and its perfect restoration with an endoprosthesis. Before an artificial joint operation, a series of necessary imaging examinations (special X-rays, MR, CT, SPECT-CT) must be carried out so that the surgeonreceives comprehensiveinformation about the operated joint. These examinations help to determine how the operation should be performed and what needs to be corrected in order to restore the original normal shape of the ankle joint.

Elbow dislocation - instability of the elbow

Supplementary interventions

In addition to the actual implantation of the endoprosthesis, the surgeon often has to perform other procedures, such as Achilles tendon lengthening, calf bone lengthening, corrective ankle screw fixation or foot or lower leg repositioning, collateral ligament reconstruction, etc. The axis of the ankle joint must be corrected and the collateral ligaments must be in balance after the operation. Post-traumatic conditions in particular, which occur in the majority of cases, often place high demands on the overall reconstruction of the ankle joint.

Precise alignment and reconstruction of the foot are crucial for the long-term success of an ankle joint endoprosthesis. However, if this reconstruction is not perfect, there is a risk of the endoprosthesis failing after some time.

Are you suffering from ankle arthrosis and looking for a specialist?


If you have a worn ankle joint, if you are in pain or if you want a movable joint and not a screwed joint, contact me with a request for an artificial joint. I have 25 years of experience with the implantation of these endoprostheses in the most difficult conditions.