Dear Michael
Your Xrays show AVN of Talus with arthritic changes in Tibiotlar(ankle ) joint as well as some arthritis in the Talo-navicular joint(midfootJoint).
Unfortunately there are not many surgical options that would provide you with long term pain relief. One of the options would be to fuse the ankle joint. This procedure will give you pain relief, but will stiffen up your ankle completely. There is not much mobility at the ankle joint currently so main benifit of the ankle fusion will be the long term pain relief. However after ankle fusion you are likely to develop pain ,discomfort and arthritis of the remaining midfoot joints few years down the line(10-15 years). If and when it happens, these joints can also be fused but they will produce further stiffness of the ankle and foot.
Unfortunately there are not many surgical options that would provide you with long term pain relief. One of the options would be to fuse the ankle joint. This procedure will give you pain relief, but will stiffen up your ankle completely. There is not much mobility at the ankle joint currently so main benifit of the ankle fusion will be the long term pain relief. However after ankle fusion you are likely to develop pain ,discomfort and arthritis of the remaining midfoot joints few years down the line(10-15 years). If and when it happens, these joints can also be fused but they will produce further stiffness of the ankle and foot.
Second option will involve ankle joint replacement. This procedure is certainly feasible, should provide you with pain relief and mobility at the ankle however artificial ankle joints do not last long(5-7 years) in young individuals. Also, poor skin condition ove the ankle joint secondary to previous injuries may complicate joint replacement surgery by increasing the chances of wound breakdown and infection. Artificial ankle implant will eventually lossen and ankle will again become painful. When it happens the usual course is to remove the artificial joint and do an ankle fusion -- which willl be significantly difficult to achieve compared to if you go for it now and will also result in significant shortening of leg as replacement involves removal of the bone from the ankle.
There are no satisfactory answers to your problem, however in my opinion better longterm results and minimal complications of ankle fusion makes it a better surgical alternative compared to ankle replacement surgery especially in young individuals leading an active lifestyle. Surgery should be delayed as long as possible and surgical intervention should only be considered if you have significant pain that is limiting your function and conservative treatment (injections in the joint, braces, physiotherapy and analgesia) have failed.
Please feel free to contract me if you have any further queries.
Good Luck!
Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK
Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon
Web: http//www.arthrocure.com
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