Arthrodiastasis

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Image Credit: Science Direct 

“Health is the thing that makes you feel that now is the best time of year.” - Franklin P. Adams

Arthritis is statistically one of the most prevalent foot and ankle conditions. As an ailment, it can be quite painful. While various treatments ranging in complexity are utilized in the medical realm, ultimately, the fix to the condition will be a practice that will either restore the joint, or induce the replacement of a part of the hinge joint. With very severe cases of arthritis, surgical treatments are the path to recovery. Individuals with severe cases of arthritis are treated in one of two ways: 

  1. Ankle Arthrodesis

  2. Arthroplasty With Implants 

While every surgical process has its pros and cons, the risk management strategy will be what your orthopaedic surgeon will utilize to determine your best treatment path forward. Minimally invasive surgical procedures do exist, but variables such as age, gender and stage of severity have major impacts on the treatment path. Surgical risks include: 

  1. Infections and Non-Unions in Ankle Arthrodesis

  2. Abnormal gait  due to minimized Ankle Movement

  3. Restricted motion 

Drawbacks of Ankle Arthroplasty include: 

  1. Not all candidates are eligible for joint replacement due to weight restrictions. Past a certain weight point, individuals are exempt from this procedure. 

  2. Joint failure within a twenty year span. Mechanical equipment is not infallible, and often individuals may end up in a situation where their joints are impacted by external pressures and stresses and strains cause the joint to fracture. Under this condition, the joint will have to be replaced with a unit that is working. 

  3. Surgical mistakes can cause additional damage to the patient. Potential surgical injuries during the joint installation include damage to the bones (bone fractures during installation), nerve and tendon, and blood vessel injury. The replacement joint may not always fuse with its new home, and it is necessary for the patient to have an additional surgery to help with the healing process. 

The treatment that is an effective replacement for the aforementioned two treatments for arthritis is ankle arthrodiastasis. With the advent of medical innovation, the treatment has proven itself effective in being an alternate treatment to either fusion treatment or joint replacement. 

How does Ankle Arthrodiastasis Work? 

Arthrodiastasis involves joint separation as a means to induce healing of the area. Evolving since the late nineteen seventies, distraction therapies proved themselves as effective therapies for the treatment of joint pain. Medical studies showed that the use of an Ilizarov frame (see image above) was a means via which the arthritic ankle could simultaneously be allowed to heal, without limiting the mobility of the joint. Fused with such a therapy, is the filling of the joint with various fluids or suspensions such as hyaluronan (a critical molecule in joint restoration), or even stem cells in an appropriate base. Regardless of the path, the aim is to restore the cartilage surfaces of a joint. Once cartilage is restored, the smooth operation of the joint will be achieved. 

Ankle Arthrodiastasis Research

From our second article reference, a total of 65 ankles were assessed for their performance after the ankle arthrodiastasis procedure was completed. The patients under study, included moderate to severe arthritis with symptoms including pain and limited range of motion. Patient age was ranging from 42.5 years to 62 years in range. The following were the patient statistics: 

  1. 41 male patients and 22 female patients 

  2. Diagnoses: Osteoarthritis(68%), Post Traumatic Arthritis (21%), Charcot Arthropathy (8%), Adult Residual Clubfoot (3%). 

The outcome of the surgical procedure was favorable, with no deep infections developing as is potential for the two alternate therapies. Of the patient pool: 

  1. Two had to revert to arthodesis due to increase in pain after 12 months. 

  2. Superficial pin site infections in eleven patients (treated by antibiotics and improved hygiene)

  3. Ligamentous laxity and instability (four patients) , treated by physical therapy and braces 

  4. Edema in six patients.

  5. Superficial necrosis in two patients (treated by wound care therapies) 

The balance of the patient pool had a normal recovery, and were able to resume their normal life activities after their complete healing.

How does arthrodiastasis of the ankle work? 

Using a series of mechanically manipulated braces, the joint is gently re-aligned via the process of mechanical unloading it and transferring the weight to the external metal scaffold. With many foot and ankle surgeons utilizing this procedure, feel free to consult with your specialist, to find out if this process will be suitable for you to utilize in your therapy. 

Ankle arthritis can be developed from various root causes, inclusive of athletics. Athletics is physically intensive, causing excessive use of the ankle joint which can result in wearing away of the joint, via degradation of the articular cartilage in the area. Utilization of the external fixator to hold the ankle in place, while healing is facilitated will be an ideal therapy. Arthritis symptoms include:

*Pain and Stiffness in the Joint 

*Wearing away of the articular cartilage

* Hardening of the surrounding bone

*Damage to the cartilage cells 

When installed, the arthrodiastasis apparatus facilitates the joint restoration, holding the joint in place, and enabling the cartilage cells to restore. While the joint itself is active, the area has minimal time to heal. The fixator, via gently pulling the joint apart, enables the body to naturally heal itself due to the additional physical support. 

Via a series of pins and wires, the external fixator is attached to the leg. The pins are attached to the bones of the ankle, and connected to the external scaffolding via the wires, and finally are connected to the external rings. The external hinge mechanism facilitates ankle mobility. With the fixator in place, the brace is in place for approximately 10-12 weeks. 

Consult with your foot and ankle surgeon today, to find out if this procedure will be ideal for your arthritis condition. For mild cases, alternate therapies might suffice, but if you feel that you are in a severe case, arthrodiastasis of the ankle will be a treatment that could facilitate healing and restoration. 

Reference Articles

  1. Ankle Distraction: https://www.hss.edu/conditions_ankle-distraction-arthroplasty.asp

  2. A New Solution For the Arthritic Ankle: https://www.podiatrytoday.com/article/4898

  3. Pros and Cons of Ankle Arthroplasty: https://healthresearchfunding.org/12-pros-and-cons-of-ankle-arthroplasty/

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