Ankle fusion

Ankle fusion

Ankle fusion

Ankle fusion

What is an ankle fusion operation?

Ankle fusion surgery (which is also known as ankle arthrodesis) is a procedure to fuse the ankle joint, so that it’s held in a static position, and it no longer flexes.

The ankle joint (aka tibiotalar or talocural joint) is the meeting of three bones in a mortise shape; the two shin bones (tibia and fibula) which form the arch of the ankle joint, and talus bone sits within the arch shape.  Beneath the talus bone is another joint – the sub-talar joint – where the talus meets with the calcaneum (heel bone).

Ankle fusion surgery fuses the tibia, fibula and talus together, and subtalar fusion fuses the talus and the calcaneum together.

Why would you need an ankle fusion – when is ankle fusion necessary?

The purpose of fusion surgery is to stop a painful joint from moving, and the commonest reason for surgery is advanced ankle osteoarthritis. Osteoarthritis is a wear and tear form of arthritis, which typically occurs because of previous trauma to the joint (such as a severe sprain or ‘inversion’ injury), or long-term instability of the joint.  The articular cartilage which covers the ends of the bones becomes worn and roughened and this in turn raises the frictional forces within the joint. Eventually the bone underneath becomes exposed, and this leads to pain, swelling, loss of movement, and misery for the person experiencing it.

Some patients will have ankle arthritis as a result of inflammatory joint disease (e.g. rheumatoid arthritis).

What happens during ankle fusion surgery?

There are two ways to carry out ankle fusion surgery. The first is an ‘open’ operation, which involves and incision on the outside (aka lateral side) of the ankle, and the second is a keyhole, or arthroscopic surgery, which is performed through three, small incisions. 90% of ankle fusion that I perform are carried out via keyhole surgery.

The process involves cutting out the worn, arthritic joint surfaces, followed by positioning 2 or 3 large screws across the joint to render it immobile. Sometimes a plate is used, if open surgery is required (or if the patient has neuropathy, and a more solid fixation is necessary).  It may sometimes be necessary to use extra bone to ensure good bonding across the fusion, and this bone is normally gathered from the person’s fibula bone, and bone is harvested via the same incision.

Once the incision holes have been closed, a plaster cast known as a combi-back slab applied around the ankle, and that stays on for three weeks. Next, the cast is removed and changed into a light weight below-knee cast for three further weeks. You’ll be non-weight bearing during this time, and then at the six week stage, I’ll remove the cast, and you’ll be able to start weight bearing, whilst wearing a boot for 4-6 weeks.

The surgery is carried out under a general anaesthetic, or sometimes using a spinal anaesthetic or nerve block to numb the leg for several hours.

How long is ankle fusion surgery?

The surgery takes around 2 hours, and after a short time in recovery, you’re able to return to the ward. Most patients stay overnight and then go home the next day when their pain is well controlled and have seen a physiotherapist.

What happens after ankle fusion surgery?

After the surgery, you’ll be given pain killing medication to keep you comfortable. The ankle will be swollen, and it’s really important to limit this by keeping your ankle elevated. You’ll need to keep your leg up, above your heart level, for the first 3 weeks, and you won’t be able to put weight on your leg, for the first six weeks. I advise my patients undergoing fusion surgery to take vitamins C and D (which aid wound and bone healing) and to abstain from smoking.

How long is ankle fusion recovery?

In most patients, it takes around three months to get back to regular activity (such as walking the dog). It could take around 3 to 6 months for ankle swelling to reduce, and swelling can be expected in the early months if you’re on your feet a lot.

How much movement is possible after ankle fusion?

You may be wondering how it’s possible to walk on ankle that doesn’t bend or flex – does ankle fusion limit mobility?

Walking after a fusion is possible because we also have movement in our hindfoot and midfoot joints. This accounts for 50% of the movement we experience during walking.

If you have pristine and fully mobile neighbouring joints, you’ll be able to function well with regular day -to -day activities, but you might struggle if you want to return to running or surfing. Cycling, swimming and hiking, are all achievable.

When can I return to work after ankle fusion surgery?

If you have a desk-based job, you may be able to return to work after a month, provided you’re able to keep your leg elevated when you’re working. If you need to be on your feet a good deal for your work, or if you have a very manual job, it will be at least 3 months before you could be back at work.

Can I run after ankle fusion?

Some people may manage to jog a little after ankle fusion surgery, but it’s not a normal jogging action, because of the limited range of movement. I encourage my patients to stay active and continue to enjoy sports but usually I advise against running regularly after ankle fusion.

Which is better, ankle fusion or replacement?

Ankle fusion has been the gold-standard operation for advanced ankle arthritis, but with advancing joint replacement technology, my viewpoint is to consider ankle replacement first, where possible. Ankle replacements are more suited to people who are over the age of fifty and they aren’t designed to take high impact activity, and when I see you in clinic, we’ll talk through your lifestyle and wishes, and I’ll be able to give you my opinion on whether a fusion or replacement would be best for you.

Ankle fusion surgery complications

No surgery can be entirely without risks, and we carefully prepare to guard against them.

Risks include, bleeding, infection, nerve damage, blood clots, skin complications, irritation of the tissues overlying the metalwork, reactions to anaesthesia and joint misalignment.

What is the recovery like after osteotomy bunion surgery?

Non-union occurs in less than 5% of patients, and this means that the ankle bones fail to fuse. The risk of this happening is much higher if you’re a smoker, or if you’re taking steroid medication. Non-fusion creates persistent pain for some patients, and it may be necessary to carry out further surgery.

Because ankle fusion completely restricts the range of movement between the tibia and the talus bone, the mid-foot joints have to work a little harder during gait. Over time, this can lead to pain and wear in the adjacent joints, and it’s why I take great care to ensure the very best alignment of ankle joint during the fusion surgery. The more high-impact activities you do post-fusion, the more stress you will put on the adjacent joints.

Occasionally, the screws may feel a little irritant to the overlying tissues, and it may be necessary to remove them (which thankfully has a quick recovery). It’s very rare that we’d need to do this, and only if it’s causing a real problem.

Ankle fusion surgery success rate

Ankle fusion surgery is successful more than 90% of the time, meaning that the ankle fuses and the person’s pain is relieved. Most ankle fusions last the test of time and it’s very rare for a successfully fused ankle to fail in the long term. In a very small group of patients, it may be possible to ‘revise’ it to an ankle replacement if the neighbouring joints developed symptomatic arthritis.

If you’re struggling with ankle arthritis, I’m here to help.