Knee and ankle arthroplasty – What results can be expected?

Abstract

Osteoarthrits is listed number one reason for adult disability. Therefore treatment of arthritis has maximum impact for the general practitioner. Disability of knee and ankle osteoarthritis causes inability to work and loss of independence. Patients will ask their physicians about expectations after total knee or ankle arthroplasty when other treatment has failed. The satisfaction rate after knee prosthesis is 75 – 89 % and for total ankle arthroplasty even slightly higher at 79 – 97 %. This is surprising because the survival in joint registry data after knee arthroplasty is 94 % compared to ankle arthroplasty significantly less at 69 % after 10 years, when a component revision is used as endpoint. In addition, knee component revision usually means exchanging to knee revision prosthesis while at the ankle it is usually prosthetic removal and conversion to ankle fusion. This difference of satisfaction is probably caused by the fact that knee arthroplasty is a standard operation and patients have very high expectations. Key to this is realistic patient education before surgery by general practitioners and specialists about the typical postoperative course with significant pain reduction not within days but rather in the first 2 postoperative years with moderate activity allowed. Candidates for total ankle replacement must be carefully selected because the prosthesis relies on a good bone stock, stable ligaments and proper limb alignment. Unlike for the knee, none of these can currently be corrected by the ankle prosthesis itself. Patients can expect significant pain reduction, better function and a slight improved range of motion after knee and ankle prosthesis. Sports activities are possible, but should be in a low-impact area. Heavy physical work or running and jumping activities are usually not possible and surely not recommended due to increased wear.