Ask the Expert: Dr. S. Robert Rozbruch, Orthopedic Surgeon, Answers Your Questions About Ankle Distraction Arthroplasty

Q1. I have AVN bi-lateral in ankles, was told replacement was not an option because of the AVN only to have them fused yet then was told replace one and fuse the other. Is this normal? Do I have options?

AVN can affect ankles to different degrees. Both fusion and replacement can be challenging because of the compromised blood supply in the talus. We have had some very positive experience using ankle distraction in cases of AVN before there is significant collapse.

Q2. I am an active man in my late fifties. After many years of playing sport, I have arthritis is my left ankle. I’m worried that I will not be able to go to the gym and play basketball after an ankle fusion. Would ankle distraction arthroplasty be another option to consider?

Yes, ankle distraction is a great joint preservation option to maintain mobility in the ankle. The distraction procedure encourages cartilage regeneration in the joint.

Q3. What is the recovery like after ankle distraction arthroplasty?

The distraction frame is worn for 10-12 weeks. During that time motion exercises of the ankle and weight bearing are encouraged. Pain relief increases gradually and tends it improve over time.

Q4. What is the main difference between an ankle fusion and ankle distraction arthroplasty?

With ankle fusion, the arthritis is removed and the tibia and talus are fused. Motion at the ankle is sacrificed for pain relief. Ankle distraction is a joint preservation procedure. In most cases, cartilage in the damaged ankle joint undergoes regeneration, motion is maintained and pain relief is accomplished.

Q5. I am scheduled to have this procedure in a few weeks. Will the rehab process be long after the external frame comes off? I’m assuming I will have to rebuild strength in my ankle after being off it for a while?

After the frame is removed, patients typically wear a removable boot for support for about a month. Pain relief progresses gradually. Physical therapy for ankle motion and strengthening is key for about three months after frame removal.

Q6. How long does the new cartilage last?

The cartilage can last for several years. I have patients with cartilage that has lasted 10 years. 75% of patients have satisfactory pain relief at seven years after ankle distraction surgery.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. My daughter was born with bilateral club foot and has had several surgeries on each foot from 9 months old until she was 9 years old. She is now 20 years old and having lots of pain in the ankle area and up through her hip. I recently took her to an orthopeodic who is recommending a subtalar fusion and calcaneal osteotomy. He also suggested that he could help remove her high arch to flatten and lengthen her foot; and straighten her toes to look more normal. Her shoe size is about a children’s size 3 but her foot is extremely wide. So finding shoes that fit is extremely difficult. Currently she cannot wear shoes because of the pain that she is having. At this point, we are looking to take one step at a time and find the best orthopeodic to treat her. Please email me your thoughts and recommendations for treatment. We live in Atlanta GA but are not opposed to traveling back home to NY of treatment.

    1. Hi Lisa — In this situation, residual deformity and arthritis of the ankle are the usual culprits.
      If you are interested in making an appointment with Dr. Rozbruch or another HSS physician, please try reaching out to our Patient Referral Service at 888-720-1982.

  2. I had a ankle fusion as I have avn since 2009 . I had 5 ops where he pitted and cleaned but didn’t work so then he decided to fuse my ankle 2014 after 13 weeks ofrecovery I was still in pain to be told the screws were to long then in November last year he removed them . My ankle has fused but the pain is very serve by the end of the day my ankle has swollen and I and not walk far with out sitting from the pain . If I had a fusion why does it hurt so much to the point I can’t walk far . .tgank you may be you can enlighten me … Sherry

    1. Hi Sherry, we’ve shared your questions with Dr. S. Robert Rozbruch for his thoughts and he has responded with the following: “There are a variety of possible reasons for pain after an ankle fusion. One reason is nonunion, meaning that the fusion is not complete. Malposition or deformity of a fusion can cause pain. Another common reason is adjacent joint arthritis. A full evaluation is necessary to determine the cause of your pain and then treatment can be rendered.”

  3. I am writing because of my 25 yr old daughter. she has the large genu valgum, hers is much worse than case 32. she constantly complains of hip pain, ect…we live outside of Nashville Tennessee. can you provide me a name of a surgeon that can help her located in Nashville?

    1. We are sorry to hear this about your daughter. We will send your note to Dr. Rozbruch for his thoughts.

  4. I had a fairly comminuted fracture of the right talus as a result of a half-jump / half-fall while rock climbing in September, 1983. The surgeon described the fracture as three big pieces and an area on the medial side of the talus below the tibia where a bone graft was screwed in place. Hawkins’ sign was a bit slow in appearing but eventually became visible on x-ray toward the end of the 12 weeks of being immobilized. Two pins left protruding through the skin surface were pulled out about 6 weeks post-op, and the remaining two screws were removed at my request a year later. The sub-talar joint showed the first degenerative changes about 1-2 years post-injury. The two most consistent points of discomfort have been in those two areas.

    The injury has plagued me ever since, but I’ve managed to stay quite active in occasional mountain climbing, a few triathlons, distance cycling and weight training. I had a short surgical procedure in May of this year to remove some excess bone, and an injection of adipose-tissue harvested stem cells in both the sub-talar joint and the ankle joint in June, but it has been a slow recovery. I rarely take any anti-inflammatory medication as I’ve read the drugs, although they provide some relief, are a contributing factor to further degeneration.

    The ankle distraction arthroplasty procedure sounds promising – does it sound like I could be a good candidate? I have a recent set of x-rays if needed.

    1. Hi Johnny, thank you for your questions. Dr. S. Robert Rozbruch, orthopedic surgeon, says: “With what you described, you sound like you may potentially be an excellent candidate for joint preservation ankle and subtalar distraction arthroplasty.” If you wish to schedule an appointment at Hospital for Special Surgery, please contact our Physician Referral Service at 800-796-0482.

  5. When I was 16 I was throw from a horse completely shattered my ankle first surgery was 18 second was 26 the doctor did more damage now need fusion. I’m 36 now how successful do you think it will be

    1. Hi Larry, thank you for reaching out. Dr. S. Robert Rozbruch, Orthopedic Surgeon, says: “It sounds like you have developed post-traumatic arthritis of the ankle. While a fusion is a very effective surgery to eliminate pain, it does leave you with a stiff ankle at a young age and this can have negative ramifications in the future. After an evaluation, it can be determined if you are a candidate for a joint preservation procedure called Ankle Distraction. This could be a good alternative option for you.” For more information on ankle distractions, visit If you wish to seek a consultation at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  6. I have Osteoarthritis of the sub tibiotalar joint that includes a grade IV chrondral loss.

    Is the Ankle Distraction procedure performed for the Sub tibiotalar joint?

    Also, I’m interested in possible cartilage transplant for my condition.

    Which Physician would be best to contact?

    Thank you.

  7. I have 2 shortened toes which need correcting. the problem is you don”t take my insurance. I have oxford freedom. The problem also is you are the one whose specialty fits my needs. What should I do?

    1. Hi Colette, HSS does not participate with Oxford. To find a physician that accepts this insurance, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  8. I am an overweight 44yr old male with AVN. Long story short, had 2 surgeries before they discovered what the real problem was. I waited 6 years for the AVN surgery, 2008, tried a fusion with a cadaver bone first, because the surgeon said I would be able to get back to work sooner, unfortunately it did not work. I had another surgery in 2010, this time using a bone from below my knee. This time the fusion worked, but now the pain is just too much sometimes. Last 2 surgeries were at Vanderbilt, and they, in my opinion, did wonderful job. The doctors I have seen have said my foot has just been cut so many times, that I probably will never be able to fully get rid of the pain nor walk distances. I rather not take the time release opiates, but do currently use the butrans patch and endocet. I want to get back to work, get my years in for retirement, plus I truly enjoy my job, I work at a govt facility, we carry M16A4 rifles and personal sidearms and have a very intensive background check, so you can see why I am so against the drugs. Thank you.

    1. Hi Jeremy, thank you for sharing. It is best for you to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  9. Hi, I have absolutely no cartilage left in my left ankle, bone on bone, due to a motorcycle accident in 1976. I am a 58 year old female. I have about 10% motion, if even, up and down and almost full motion side to side. Due to bone on bone, would cartilage regeneration via ankle distraction be possible? would distraction be considered? I do not want to fuse, as I still have, even if very little, motion left. I am not in severe pain, only painful at times when stiff, although I can only wear rocker bottom sneakers, which let me walk almost normal.

    1. Hi Kathy, thank you for reaching out. Dr. Robert Rozbruch, Orthopedic Surgeon, says: “Ankle distraction could be a good option for you as it can avoid fusion and help preserve the motion that you do have in your ankle.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  10. Hi, I have just been diagnosed with stage 3 OCD in my right ankle, the talus bone. I have been told that I need surgery & if I do not have the surgery, I would need a total ankle replacement in 3 to 5 years. How common is this disease & are there other options other than surgery…

    1. Hi Rose, thank you for reaching out. Dr. Jonathan Deland, Foot & Ankle Surgeon, says: “OCDs are a fairly common problem. Certainly large OCDs are best treated with surgery if they are symptomatic. However, not having surgery for even a large OCD will not necessarily result in requiring a total ankle in five years.” It is best to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  11. Can a ankle distraction help with a OcD of talus with the articular cartilage is worn out. I have had two previous failed surgeries. (drilling of defect) Is there any operative procedures that would help.

    1. Hi Janie, thank you for reaching out. Dr. S. Robert Rozbruch, Orthopedic Surgeon, says: “Yes, ankle distraction combined with stem cells and cartilage graft can help you.” If you are interested in receiving care from Dr. Rozbruch or other surgeons at HSS, please contact our Physician Referral Service at 877-606-1555.

  12. It seems like this could potentially provide longer lasting relief than the drilling procedure where you hope to stimulate cartilage by drilling the bone in the area of the cartilage lesion.

    1. Hi Matthew, thank you for reaching out with your question. Dr. Robert Rozbruch, Orthopedic Surgeon, says: “Ankle arthritis can be treated with fusion and it is excellent for pain relief in the short term. However, loss of joint motion and increased stress on adjacent foot joints is possible. These can become painful over time and lead to need for additional joint fusion and decreased joint motion. Ankle distraction is a good alternative for patients with arthritis and well-preserved joint motion. This joint preserving procedure which encourages cartilage regeneration and reversal of arthritis preserves ankle motion and is effective for relief of pain.” To determine the best course of treatment, please speak with your treating physician. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555.

If you’d like to consider HSS for treatment, please contact our Patient Referral Service at 888-720-1982. For general questions and comments, reach us on Facebook or Twitter.