Ankle Fusion
Ankle fusion is a surgery commonly used to treat ankle arthritis. It is sometimes known as ankle arthrodesis surgery and was the gold standard treatment till the advent of modern ankle replacements, which now show equally good outcomes.
Why have the surgery?
Ankle arthritis is the commonest reason to fuse the ankle joint. This is usually when all non-surgical options have been exhausted. It can also be used in complex foot drop conditions which are not amenable to tendon transfers.
How is surgery performed?
The operation is typically performed under a general anaesthetic. If there is minimal deformity and bone loss, then it possible to perform the surgery in a minimally invasive keyhole manner. If there is deformity or there is bone loss which needs bone grafting, the surgery is performed through a midline approach from the lower shin to the top of the foot. Irrespective of the approach, the surgery then involves taking out the joint surfaces, bringing the raw exposed bone together and using screws or plates to hold the ankle in place whilst healing takes place.
What are the benefits?
The operation carries a greater than 90% of resolving ankle pain in the appropriately selected patient. By improving pain, often function such as standing and walking will become easier.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Non-union, meaning that the bone does not heal and the pain continues. - Arthritis occurring in the surrounding joints, since the stiffness at the ankle joint can place extra stress on the other mobile joints and leads to them wearing out over time. - Blood clots, which can form in the leg and travel up to the lung where they can be fatal. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
All surgeons have different protocols after surgery. Mr Patel typically keeps a patient in a plaster cast for three months, although it is only in the first month that no weight-bearing activity is allowed. Progressive weight-bearing is allowed in the second month and full weight bearing is allowed in the third month. This protocol is tried and trusted and has consistently led to high rates of union for more than 10 years.
Any other considerations?
Many patients will think that once the ankle is fused, they will not be able to move the foot. It is important to appreciate that the up and down motion that occurs when walking is combination of the foot and ankle moving, and often it is not possible for an observer to see which ankle has been fused when a patient walks.