Amanda Wilde (Host): Ankle arthritis has to do with
the wearing down of cartilage. It's painful and it's progressive, but there are
treatment options that can improve your pain and mobility. We'll address why
ankle arthritis happens, how it's diagnosed, and the latest treatment options
with our guest, Dr. Kyle Natsuhara. Dr. Natsuhara is a fellowship-trained
orthopedic surgeon with a focus on treatment of the foot and ankle.

This is Hello Healthy, a Dignity Health Podcast. I'm Amanda
Wilde. Dr. Natsuhara. Thank you for being here.

Dr Kyle Natsuhara: Thanks for having me on, Amanda. I
appreciate being able to talk about ankle arthritis and some of the treatments.

Amanda Wilde (Host): Is ankle arthritis fairly
common?

Dr Kyle Natsuhara: Ankle arthritis is actually less
common than, say, hip or knee arthritis, which most people know about. I think
there are several reasons for that. The primary is probably due to the anatomic
conformity of the ankle joint. And what I mean by that is that the talus bone,
which makes up the bottom part of the ankle joint, is firmly bound by some of
the bony and ligamentous constructs that give it a better cartilaginous loading
profile. That being said, it's just as debilitating as hip or knee arthritis.
They actually did a study comparing the two and the pain and disability scores
were similar. The primary risk factor for ankle arthritis is post-traumatic in
nature, meaning if you had an ankle fracture or fracture that involved part of
the ankle joint itself, you have a much higher risk of developing arthritis
later on.

Amanda Wilde (Host): So if you've already weakened
the joint?

Dr Kyle Natsuhara: Correct. Yeah. And so, whether
it's the bony fractures or if you have ankle instability such as chronic
ligament injury, that can also lead to ankle arthritis as well.

Amanda Wilde (Host): So, you're talking about risk
factors. Is there such a thing as preventive care?

Dr Kyle Natsuhara: That's a good question, and I
think people have looked into it. Like I mentioned, it's a little different
than hip or knee. It's mostly due to after a trauma. So obviously, it's hard to
prevent trauma in your life. But there has been some data that looked into diet
or healthy living lifestyles or lower impact activities that may help prevent
the progression of arthritis.

Amanda Wilde (Host): Yeah. And what about wearing
braces or corrective shoes?

Dr Kyle Natsuhara: That's part of some of the
non-operative treatment options we have. Bracing and shoewear modification are
both helpful. The main reason is to decrease the amount of motion through the
ankle joint or help give you more support that helps decrease the pain related
to the arthritic motion of the joint. So, they definitely can be helpful. You
can also try mechanical unloading options such as a cane or assistive device.
Otherwise, medications can help relieve pain or even sometimes we'll do
selective joint injections into the ankle joint to help relieve some of your
pain and symptoms.

Amanda Wilde (Host): So, you just mentioned
non-surgical options. Are there also surgical options and when do you use
those?

Dr Kyle Natsuhara: Non-operative options are always
the first line treatment for ankle arthritis. That being said, if a patient
does not achieve the amount of pain relief or symptom management they desire,
that helps them get back to the activity level or quality of life that they
want, then surgery is an option.

Amanda Wilde (Host): And what does that look like?

Dr Kyle Natsuhara: There are several surgical
options. I think for the purpose of this talk, we'll talk about the two main
surgical options for advanced or end-stage ankle arthritis, and those are ankle
fusion or arthrodesis as it's sometimes referred to or a total ankle
replacement.

Amanda Wilde (Host): Okay. So, ankle fusion seems
self-explanatory, but can you describe that a little bit? And then, ankle
replacement, I don't know what that is. Is that with a device?

Dr Kyle Natsuhara: Yeah. So first, we'll talk about
the ankle fusion procedure. So, what that is is you fuse or kind of knit the
two bones making up the ankle joint together, which is the end of the tibia
bone and the talus bone. And you'll hold those together with plates or screws
until those bones fuse together. And because you're getting rid of the joint,
you then get rid of the pain associated with that arthritic joint. Obviously,
the downside to that is by getting rid of the joint, you lose the motion of
that joint, which is the up and down motion of your ankle joint.

Historically, this has been the gold standard treatment and
patients can functionally do well with a fused ankle joint as they are able to
compensate with some of the surrounding joints in the foot and ankle, or modify
their shoewear or braces. Patients have a little harder time with uneven ground
or crouching down and those types of activities.

Amanda Wilde (Host): And is the fusion permanent?
Does that last forever?

Dr Kyle Natsuhara: In theory, yes. There have been
reports where people can actually take down an ankle fusion and switch it over
to an ankle replacement, but that is a little less common, but it can be done.

Amanda Wilde (Host): And let's talk about ankle
replacements and what that means.

Dr Kyle Natsuhara: So, an ankle replacement is
similar to like a knee replacement. Most people are a little more familiar with
that. And it's where you take the surface off of the degenerative tibia and
talus that make up the ankle joint and you replace that with metal and a
plastic insert so that they can articulate or move together, and therefore
decreasing the pain and preserving the motion of the joint.

Amanda Wilde (Host): And how long do ankle
replacements last when you compare them to the more common knee replacement?

Dr Kyle Natsuhara: Historically, the ankle
replacements did not last or do as well as the total knee replacements. But as
the technology has significantly improved, we're now seeing results similar to
a knee replacement, meaning about 10 plus years.

Amanda Wilde (Host): And then, do you have to get it
replaced again?

Dr Kyle Natsuhara: I guess it depends on the reason
why the ankle replacement fails. Sometimes you can go in for a quick tuneup,
change out the plastic liner or clean up some of the parts of the joint itself.
But if there are more severe problems, then you do have to replace the whole
joint.

Amanda Wilde (Host): You were saying that recent
developments have made ankle replacement about as successful as knee
replacement. What do you think you'll see in the future as techniques to treat
ankle arthritis continue to evolve?

Dr Kyle Natsuhara: The technology for ankle replacements
is moving very quickly. One of the newer innovations in ankle replacement is
patient-specific instrumentation and cutting guides, meaning we'll take a CT
scan of a patient's ankle and the company will print out specific guides that
are specific to that patient's anatomy to help more reliably reproduce putting
in the implants in a correct position that matches the patient's anatomy. I
think some of the implants have better in-growth technology as well to make
them more stable and to last longer.

Amanda Wilde (Host): So, it's becoming more
individualized and also more accurate.

Dr Kyle Natsuhara: That's correct, and really that's
the goal. And I think that's one of the main differences between the older
generations of ankle replacements, is that we're trying to restore the
patient's anatomy closer and taking less of their bone so that their native
anatomy can be preserved. And I think that's been a huge difference in terms of
how long these ankle replacements are lasting.

Amanda Wilde (Host): Well, Dr. Natsuhara, we look
forward to future developments in the treatment of ankle arthritis. Thank you
so much for sharing your techniques and your time and your insights today.

Dr Kyle Natsuhara: Thank you so much for having me
on.

Amanda Wilde (Host): That was orthopedic surgeon, Dr.
Kyle Natsuhara. For more information, visit dignityhealth.org/stockton/ortho.
And if you found this podcast helpful, please share it on your social channels
and be sure to check out the full podcast library for topics of interest to
you. This is Hello Healthy, a Dignity Health Podcast. I'm Amanda Wilde. Stay
well.