Ankle fusion for arthritis

Shelain Patel

Ankle fusion, also called ankle arthrodesis, is an operation that removes the painful movement from an arthritic ankle by joining the bones of the ankle joint together.

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It has been an established treatment for severe ankle arthritis for many years and remains an important option for selected patients.

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The aim is to reduce pain and provide a stable, solid ankle.

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What is an ankle fusion?

The ankle joint is formed primarily by the tibia, fibula and talus. During an ankle fusion, the damaged joint surfaces are prepared and the bones are positioned appropriately. Fixation, usually using screws and sometimes other implants, holds the bones in position while they heal together. Once fusion has occurred, the ankle no longer moves through the fused joint.

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Who may be considered for ankle fusion?

Ankle fusion may be considered for patients with:

• severe painful ankle arthritis

• post-traumatic arthritis

• significant deformity

• previous unsuccessful ankle surgery

• certain cases of infection or previous infection

• circumstances where ankle replacement is unsuitable

The decision is individual and depends on the condition of the ankle and the rest of the foot.

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What are the potential advantages?

The principal aim of fusion is pain relief. Potential advantages include:

• removal of painful movement

• a stable ankle

• correction of some deformities

• established long-term treatment for severe arthritis

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What are the disadvantages?

The principal consequence is loss of movement at the ankle joint. Movement is not necessarily eliminated from the entire foot. The subtalar, midfoot and other joints continue to move and can compensate to some degree. However, altered mechanics may increase the demands placed on neighbouring joints.

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How does ankle fusion affect walking?

Most patients can walk after a successful ankle fusion. Walking mechanics change because the ankle no longer moves normally. The other joints of the foot and the knee can contribute to the overall movement required for walking. The effect varies between individuals and depends on the condition of the rest of the foot.

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How is ankle fusion performed?

Ankle fusion can be performed using different surgical techniques depending on the individual anatomy and previous surgery.

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The operation may involve:

• preparation of the joint surfaces

• correction of deformity

• bone graft where appropriate

• fixation using screws or other implants such as plates or staples

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The aim is to obtain a stable position that allows the bones to unite.

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Recovery after ankle fusion

Recovery varies according to the procedure and individual circumstances. Patients generally require a period of protected weight-bearing while the fusion heals.

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The precise rehabilitation programme depends on:

• the surgical technique

• bone quality

• additional procedures

• general health

• evidence of healing on follow-up imaging

Your surgeon will provide a personalised rehabilitation plan.

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What are the risks?

Potential complications include:

• infection

• wound problems

• nerve irritation or injury

• blood clots

• failure of the bones to unite

• malalignment

• persistent pain

• problems with metalwork

• arthritis in neighbouring joints

Smoking can adversely affect bone healing and is an important consideration when planning fusion surgery.

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Ankle fusion or ankle replacement?

Both procedures aim to treat painful advanced ankle arthritis, but they achieve this in different ways:

• Ankle fusion eliminates movement at the ankle joint.

• Ankle replacement removes the damaged joint surfaces and introduces an artificial joint designed to preserve movement.

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The choice depends on factors including:

• age

• activity

• ankle alignment

• bone quality

• deformity

• stability

• previous surgery

• associated arthritis

• expectations

Read the detailed [ankle replacement versus ankle fusion guide].

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Can an ankle fusion be converted to a replacement?

In selected circumstances, an ankle fusion can potentially be converted to an ankle replacement. However, this is a complex procedure and is not appropriate for every patient. The condition of the bone, alignment, surrounding joints and previous surgical history all need to be assessed carefully.

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Frequently Asked Questions

Does ankle fusion eliminate ankle pain?

The principal aim is to reduce pain arising from the arthritic ankle joint. It does not guarantee that all pain around the ankle or foot will disappear.

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Will I be able to walk normally after an ankle fusion?

Most patients can walk, but gait mechanics change because the fused ankle no longer moves.

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Can I run after ankle fusion?

High-impact running is generally significantly affected by loss of ankle movement, although activity recommendations vary between individuals.

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Is ankle fusion permanent?

A successful fusion permanently joins the bones of the ankle joint.

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Is ankle replacement better than fusion?

The two procedures have different advantages and limitations. The appropriate option depends on the individual rather than one procedure being universally suitable.

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Book a consultation

If you have advanced ankle arthritis and are considering surgery, specialist assessment can help determine whether ankle replacement, fusion or another treatment is appropriate.

[Book a consultation with Mr Shelain Patel]