Ankle Replacement Alternatives

Posted on December 16, 2022 in Total Ankle Replacement by Dr. Erik Nilssen

The pain and limited mobility caused by ankle arthritis can make daily life challenging and negatively affecting an individual’s overall quality of life. In addition, this limited mobility and frequent pain often lead to anxiety and depression. At North Florida Bone & Joint, we are dedicated to improving our patients’ quality of life by addressing their symptoms using conservative treatments and, when necessary, surgical intervention.


While there are times when ankle replacement surgery is the only option, sometimes alternative treatments can be used to address ankle arthritis. Our patients know that at North Florida Bone & Joint Specialists, we only recommend surgical intervention when it is absolutely necessary. Individuals with advanced ankle arthritis will most likely require ankle surgery; however, those with moderate or mild arthritis in the ankle may find relief through nonsurgical methods.


Surgical alternatives include physical therapy sessions, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), special orthopedic devices or braces and/or activity modification. Another useful tool for temporarily relieving pain is proliferation therapy.


According to a study conducted by Caring Medical and published in Practical Pain Management, proliferation therapy (also referred to as Prolotherapy or regenerative injection therapy) is an effective nonsurgical alternative to ankle replacement surgery. Prolotherapy refers to injecting a solution into the ligaments, tendons or joint space as a means to address laxity in the ligament or to reduce pain.

The 19 patients involved in the Caring Medical study made a significant improvement in relation to their:

  • ability to exercise;
  • range of motion;
  • walking ability;
  • daily living activities; and
  • ankle stiffness.

In addition, participants stated that their depression and anxiety levels decreased. All study participants were able to reduce a number of medications they were taking. Furthermore, all 19 of the study participants have recommended proliferation therapy to someone else.


If more conservative approaches do not provide the patient with long-term relief, surgical intervention will typically be advised. While ankle replacement surgery is the preferred treatment, an ankle joint fusion is the surgical alternative used in place of TAA. An ankle joint fusion involves preventing movement between the surfaces of the ankle joint through the insertion of screws, pins or plates. After this surgery, the bones of the ankle remain in a stationary position. TAA is preferred over fusion because as time passes, the excess strain placed on surrounding joints and tissues may lead to arthritis in other areas of the leg and foot. Patients usually experience gait problems as well. Other potential problems include damage to the soft tissue, pain, reduced mobility, and fractures. Over time, the screws/pins that were used to stabilize the ankle joint may break. Moreover, the bones themselves may fail to fuse.


Arthroscopic debridement may be used when a patient has mild to moderate arthritis; however, this procedure is performed less frequently than ankle joint fusion or ankle replacement surgery. Arthroscopic debridement may be recommended for individuals who have symptoms associated with the presence of bone spurs near their ankle joint. During a debridement procedure, the surgeon places a viewing scope into the joint. The damaged tissue is removed from the surface of the joint itself and the area surrounding it.

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