Post-Traumatic Arthritis: It Can Develop in Your Ankles or Other Joints Long After An Injury

What exactly is post-traumatic arthritis? It’s not related to typical osteoarthritis, the most common degenerative joint disease fueled by years of “wear and tear.” The post-traumatic form of arthritis can develop with substantial pain and discomfort months -- and even years -- after an injury.

A prominent golfer recently required fusion surgery to treat arthritis caused by a previous talus fracture. A talus fracture refers to a break in one of the bones that forms the ankle. This type of fracture often occurs during high-impact traumas, such as an injury from a car collision or a fall from a significant height.

Posttraumatic arthritis results from the injury to the joint. If a broken bone or fracture extends into a joint, it will damage the smooth cartilage that covers the joint's surface. Over time, the joint breaks down and becomes arthritic. Post-traumatic arthritis can also occur following an injury to the calcaneus, the large bone forming the heel.

Justin M. Weatherall, M.D., orthopedic surgeon with Baptist Health Orthopedic Care.

“Post-traumatic arthritis is not common after ankle fractures, but it is common after fractures to either the calcaneus (heel bone) or the talus bone which sits between your ankle and the subtalar joint,” explains Justin M. Weatherall, M.D., orthopedic surgeon with Baptist Health Orthopedic Care. “Post-traumatic arthritis of the subtalar joint develops from trauma to either the talus and/or the calcaneus that disrupts the alignment of the joint or causes damage to the cartilage that makes up the joint. It typically develops months to years after the injury occurs.”

An ankle fusion (arthrodesis) surgery treats arthritis by joining the ankle bones using screws or plates to eliminate the pain. During subtalar fusion, the remaining cartilage in the joint between the talus bone and calcaneus bone is removed, and the joint surfaces are fused with screws to hold the bones in place while they heal. The goal is to improve function and reduce or eliminate pain.

“A subtalar fusion is a procedure to eliminate the subtalar joint and to cause the two bones that make up the subtalar joint to grow together,” said Dr. Weatherall. “Those two bones are your talus and calcaneus (heel bone). A surgeon will remove what is left of the cartilage of the joint -- and then prepare the underlying bone surfaces to encourage them to grow together. The calcaneus and talus will then typically be screwed together until the bone from the talus and calcaneus grow together.”

Most patients can start putting weight on the leg six weeks after the surgery, and typically the bones will be fused together in three to six months, he adds.  Your orthopedic surgeon will consider all treatment options before proceeding with a subtalar fusion.

Total ankle replacement, or ankle arthroplasty, replaces damaged parts of the ankle with a metal implant. Ankle replacements are very similar to knee replacements. Patients with ankle arthritis who are experiencing pain and decreased mobility that do not improve with other treatments are good candidates for this joint replacement procedure.

Many people do not realize that ankle replacement surgery is an option, Dr. Weatherall points out. Although total ankle replacement surgery is not as common as knee and hip replacement, Dr. Weatherall has been performing the procedure for over 10 years. Since he is fellowship trained in foot and ankle surgery, the number of total ankle replacement surgeries — and other foot and ankle surgeries — he performs is much higher than other surgeons who do not have the same training and experience.

“Wear and tear arthritis is very common in the hip and knee, but not in the ankle and subtalar joint,” said Dr. Weatherall. “Approximately 70 percent of cases of ankle arthritis are due to trauma with the remaining being due to deformity, ligamentous laxity, inflammatory arthritis, or infection.”