Thread by @DrAdamBitterman

It's time for a new and updated #orthotwitter thread on ANKLE ARTHRITIS!

A 🧵*....

*This will be as inclusive but brief. This may not include everything but will provide an overview of this topic. These slides are mine.

@AOFAS @AAOS1 #MedTwitter @MedTweetorials

1/?

The Ankle Joint is composed of three bones:
-Tibia
-Fibula
-Talus

There is cartilage between each articulation.

2/?

When the diagnosis of ankle arthritis is brought up, it is referencing the CARTILAGE LOSS between the TALUS and the TIBIA.

Here are some basic science facts surrounding this phenomena:

3/?

What are some of the main causes of ankle arthritis? Great question!

Posttraumatic Arthritis is the MOST COMMON CAUSE!

4/?

So, let's dig a little bit deeper...

What brings upon the joint wear-and-tear after a traumatic injury?

1. Instability

5/?

2. Joint Incongruity

Obtaining an anatomic reduction at the joint is vital to one's long term success. Why? It's all about contact pressure at the tibiotalar joint. With displacement, the joint will deteriorate over time leading to the hallmark arthritic changes.

6/?

Tibiotalar Arthritis comes in all different shapes and sizes - with and without deformity.

Be sure to keep in mind there is a patient behind the arthritis....many of whom may have significant medical comorbidities that need to be taken into account.

7/?

How do you treat ankle arthritis?

Not all arthritis needs surgery! Some do!

8/?

What about the surgical options?

Ankle Distraction (Fine indications)
Ankle Replacement
Ankle Fusion

9/?

We have come very far in our surgical capabilities but these surgeries are not for everyone. Let me explain..

Ankle fusion and ankle replacements have specific indications for utilization.

We are getting better and these are relative and not strictly enforced.

10/?

Ankle replacements do well!

11/?

There are always ways to improve. We can get better by ensuring the foot is corrected if underlying deformity exists. Our outcomes will continue to improve as our technology advances.

12/?

Overall, we continue to get better and better. Ankle replacement and ankle fusion are great treatment options for ANKLE ARTHRITIS!

We will get to the bullseye more consistently in due time.

13/?

In Summary - The finish line is a ways away. We are getting there but requires more research, trials and data.

We are constantly challenging what is/was thought of as the gold standard..

14/?

Be sure to speak to your patient and make a TEAM decision!

No two clinical scenarios of ankle arthritis are the same!

@NorthwellHealth @ZuckerSoM

15/?

Thank you!

Feedback welcome.

16/16

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