![How to Regrow Cartilage & Reverse OsteoArthritis? [Can We Do It?]](https://www.michiganfootdoctors.com/wp-content/cache/flying-press/6f8bfd0a4becc695adbde1cd9df37f15.jpg)
Watch: How to Regrow Cartilage & Reverse OsteoArthritis? [Can We Do It?] — MichiganFootDoctors YouTube
The most important clinical decision with Ankle Distraction Arthroplasty Joint Preservation Ankle Arthritis isn’t which treatment to start with — it’s which subtype or underlying cause you actually have. That distinction changes everything. Call us: (810) 206-1402
What Is Ankle Distraction Arthroplasty?
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
For younger patients facing the difficult choice between ankle fusion and ankle replacement for advanced ankle arthritis, a third option exists that most patients — and many physicians — aren’t aware of: ankle distraction arthroplasty. This procedure uses an external fixator to distract (separate) the tibiotalar joint by approximately 5mm for 3 months, unloading the cartilage surfaces while allowing weight-bearing through the fixator. The resulting low-load, fluid-rich environment enables fibrocartilage regeneration in a joint that would otherwise have no capacity for self-repair.
The procedure was pioneered by Dr. van Roermund and Professor Lafeber at Utrecht University in the Netherlands in the 1990s, and has since been validated in multiple clinical trials. Distraction arthroplasty is not a cure — it doesn’t restore hyaline cartilage — but it reliably reduces pain, improves function, and delays or avoids fusion or replacement in well-selected patients for 5–10+ years.
Who Is a Good Candidate?
Patient selection is the key determinant of success. Distraction arthroplasty is most appropriate for patients who are under 55, have moderate-to-severe tibiotalar arthritis (Takakura Stage 2–3), have adequate bone quality, and most importantly — have motivation and lifestyle to tolerate 3 months in an external fixator with restricted activity. The procedure is less successful in patients with severe deformity, morbid obesity, significant peripheral artery disease, or prior ankle infection.
In our practice, we present distraction arthroplasty as one option in the joint-preserving surgery conversation for younger patients who are devastated by the prospect of ankle fusion — the permanent loss of motion is a significant lifestyle impact for active people in their 30s and 40s. We have an honest discussion about what distraction offers (motion preservation, pain reduction, time) and what it demands (3 months of external fixator, significant compliance, uncertain longevity).
Key takeaway: Distraction arthroplasty is a motion-preserving bridge procedure — not a cure. Realistic expectations are 5–10 years of meaningful improvement before the arthritis progresses to the point where fusion or replacement becomes necessary. For a 35-year-old, buying a decade of function before fusion at 45 is a meaningful gain.
The Procedure and Recovery
Distraction arthroplasty is performed under general or regional anesthesia. An Ilizarov or Orthofix ring external fixator is applied across the ankle, and the joint is gradually distracted to 5mm using the fixator’s adjustable struts. The fixator remains in place for 12–14 weeks, during which patients are encouraged to bear weight through the frame — this intermittent loading is essential to stimulate the metabolic changes in the cartilage.
After fixator removal, physical therapy addresses the significant stiffness and muscle atrophy that develops during the fixator period. Most patients achieve meaningful pain reduction and functional improvement by 6–12 months post-op. Published results show 70–80% good-to-excellent outcomes at 2 years, declining to 60–70% at 5 years — superior to the natural history of untreated advanced ankle arthritis.
⚠️ Distraction arthroplasty is NOT appropriate if:
- Age over 55–60 (outcomes decline significantly in older patients)
- Severe varus or valgus deformity (>15 degrees) — deformity correction is needed first
- Active ankle infection or prior osteomyelitis
- Significant peripheral artery disease — external fixator pins are high-infection risk without adequate perfusion
- Inability to comply with 3-month fixator protocol and rehabilitation
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your ankle instability, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Frequently Asked Questions
How does distraction arthroplasty compare to ankle fusion?
Ankle fusion reliably eliminates pain (90%+ success) but permanently eliminates ankle motion. Distraction arthroplasty preserves ankle motion and reduces pain for most patients, but results are less predictable and many patients eventually progress to fusion or replacement. For younger patients where preserving motion for 5–10 years matters greatly, distraction is worth the additional complexity and recovery demands.
Can you have ankle distraction if you’ve already had other ankle surgery?
Yes, in many cases. Prior arthroscopy, ligament reconstruction, or fracture fixation doesn’t necessarily preclude distraction. Prior ankle fusion is a contraindication. The key assessment is whether adequate joint space and cartilage remnants remain for distraction to have something to work with — this is evaluated on weight-bearing CT and MRI before recommending the procedure.
The Bottom Line
Ankle distraction arthroplasty is an underused, motion-preserving option for younger patients with moderate-to-severe ankle arthritis who aren’t ready for fusion or replacement. It demands significant patient commitment and has a real recovery burden — but for the right patient, it offers a meaningful period of improved function without sacrificing ankle motion. If you’re under 55 with ankle arthritis and want to explore all options before committing to a definitive procedure, a consultation focused specifically on joint preservation is worth having.
Sources
- Marijnissen AC, et al. Ankle distraction arthroplasty as treatment of end-stage ankle osteoarthritis. Best Pract Res Clin Rheumatol. 2010.
- Ploegmakers JJ, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage. 2005.
- Daniels TR, et al. Surgical treatment of ankle arthritis. Instr Course Lect. 2004.
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Township, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
How long does the external fixator stay on during ankle distraction?
The external fixator is typically worn for eight to twelve weeks. During this time, you remain weight-bearing and can walk with a flat-bottom shoe. The frame requires twice-daily pin site cleaning and regular follow-up appointments. Most patients can perform desk work within two weeks. The fixator is removed in an outpatient procedure under local anesthesia.
Can I still have ankle fusion or replacement if distraction does not work?
Yes. Because distraction arthroplasty does not alter joint anatomy — no bone is removed, no hardware is permanently implanted — patients who do not achieve adequate improvement can proceed to either ankle fusion or total ankle replacement without any compromise to those procedures.
What is the success rate of ankle distraction arthroplasty?
Published studies report approximately 75 percent of patients avoid conversion to fusion or replacement at five years, and about 65 percent maintain results at ten years. Patient satisfaction ranges from 70 to 85 percent. Success is strongly influenced by patient selection — younger patients with moderate arthritis and good alignment achieve the best outcomes.
Is ankle distraction arthroplasty painful?
Postoperative pain is moderate and managed with oral medications for one to two weeks. Daily discomfort with the external fixator includes pin site tenderness and gait modification. After frame removal, most patients report progressive improvement as the ankle adapts and cartilage regeneration matures.
Who should not have ankle distraction arthroplasty?
Patients with advanced bone-on-bone arthritis with no residual cartilage, significant talar avascular necrosis, active infection, severe peripheral neuropathy, poorly controlled diabetes, or heavy tobacco use are generally not candidates. The ideal candidate is under 55-60 years old with moderate arthritis and good alignment.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.