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Ankle Fusion

What is Ankle Fusion?

Ankle fusion, also known as ankle arthrodesis, is a surgical procedure commonly employed for the treatment of ankle arthritis in which the joint cartilage is severely damaged. The procedure involves fusion of the bones that form the ankle joint into one piece, which eliminates joint motion and relieves pain originating from the arthritic joint.

Arthritis is the inflammation of a joint as a result of degeneration of the smooth cartilage that lines the ends of the bones within. This degeneration of cartilage causes painful rubbing of the bones, leading to swelling, joint stiffness, and restricted movement.

Anatomy of the Ankle

The ankle joint connects the leg to the foot and comprises three bones: The tibia, fibula, and talus. The tibia (shinbone) and fibula (calf bone) are the bones of the lower leg that articulate with the talus (ankle bone), enabling up-and-down movement of the foot. The joint surfaces of all these bones are lined by a thin, tough, flexible, and slippery surface called the articular cartilage, which acts as a shock absorber to cushion and reduce friction between the bones. The cartilage is lubricated by synovial fluid, which further enables smooth movement of the bones. Ligaments are tough, rope-like bands that connect bones to other bones, holding them in place to provide joint stability.

Indications for Ankle Fusion

Ankle fusion surgery is recommended when conservative treatment measures such as medications and injections have failed to relieve the arthritic symptoms. You may be a suitable candidate for ankle fusion if you exhibit the following:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Pseudoarthrosis
  • Avascular necrosis
  • Posttraumatic arthritis
  • Ankle fracture with severe cartilage damage
  • Failed total ankle arthroplasty
  • Revision of failed total ankle arthroplasty

Preparation for Ankle Fusion

In general, preoperative preparation for ankle fusion surgery will involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from supplements or medications such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least a week before surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be requested from you after the surgical procedure has been explained in detail.

Procedure for Ankle Fusion

Ankle fusion surgery may be performed as an open surgery, where a large incision is made, or as a minimally invasive arthroscopic surgery, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and miniature surgical tools. Open surgery is the commonly employed approach and involves the following steps:

  • You will lie on your back on the operating table under regional or general anesthesia.
  • An incision is made from either the anterior (front) aspect, or lateral (side) aspect of the ankle.
  • The underlying muscles are carefully separated to expose the ankle joint area.
  • Your surgeon removes any remaining cartilage from the affected joint and prepares the joint surface for fusion.
  • The joints are then fused together with the help of screws, wires, plates, or rods.
  • Bone grafting may be performed in cases of substantial bone loss. This is done using a graft taken from another part of your body (autograft) or from donor tissue (allograft).
  • Your surgeon will also perform any other required repairs in the treatment area.
  • Finally, the overlying soft tissue and skin are closed with sutures and sterile bandages are applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after ankle fusion surgery will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the ankle area. Pain and anti-inflammatory medications are provided as needed.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • Ice packs covered with a towel can be applied to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
  • Do not bear weight on the operated leg. A walking boot or non-weight-bearing cast is recommended for a few weeks to facilitate healing and support the foot.
  • Assistive devices such as crutches and walkers are recommended for several weeks to maintain balance and stability while walking.
  • At least 6 to 8 weeks may be required for your ankle bones to fuse sufficiently to start weight-bearing on the operated leg.
  • Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
  • Start rehabilitation (physical therapy) as recommended by your surgeon to improve range of motion. You should begin appropriate exercises to stretch and strengthen the foot muscles.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Recovery from ankle fusion usually takes about 4 to 6 months. Refrain from strenuous activities and lifting heavy weights during this period.
  • You can return to sports once the foot has regained its normal strength and function, and with your surgeon's approval.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Ankle fusion surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Damage to nerves and vessels
  • Thromboembolism or blood clots
  • Anesthetic/allergic reactions
  • Non-union of bones
  • Hardware failure
  • The Arthroscopy Association of North America
  • The American Osteopathic Academy of Orthopedics (AOAO)
  • The American Academy of Orthopaedic Surgeons
  • American Orthopaedic Foot & Ankle Society® Orthopaedic Foot & Ankle Foundation
  • American Academy of Osteopathy
  • American Osteopathic Association