Ankle Fusion

What is Ankle Fusion Surgery?

Ankle fusion surgery, or ankle arthrodesis, is a procedure in which the bones that comprise the ankle joint are fused together to alleviate severe arthritis pain. If you are experiencing ongoing pain in your ankle(s) and non-surgical treatment options haven’t provided effective relief, it may be time to consider ankle fusion (arthrodesis) surgery.

Ankle fusion surgery is never a first-line treatment for arthritis pain but can improve quality of life and offer a return to physical activity for patients who have exhausted less invasive options without success. The procedure can be used to treat various forms of arthritis, including osteoarthritis (wear-and-tear arthritis), post-traumatic arthritis (arthritis that develops as the result of an injury to the ankle joint), or rheumatoid arthritis (an autoimmune disease).

The goal of ankle arthrodesis surgery is to reduce or eliminate pain altogether and allow for improved activity by fusing together the bones of the ankle joint. The surgery does decrease motion in the ankle joint but can still be a highly viable solution for many patients.

Anatomy of the Ankle Joint

The ankle joint is the synovial joint that connects the foot with the lower leg. Though it is often referred to as a single joint, the ankle joint is actually composed of two separate joints: The true ankle joint (which is made up of the tibia, fibula, and talus bones) and the subtalar joint (which is composed of the talus and the calcaneus, or heel bone).

Cartilage in a healthy ankle joint allows the bones to articulate smoothly and painlessly with virtually no friction. When arthritis breaks down or damages this cartilage, pain, inflammation, and stiffness can occur.

Indications for Ankle Fusion Surgery

Ankle fusion surgery may be indicated in patients with ankle arthritis if:

• Pain is severe, ongoing, and negatively impacting overall quality of life.
• Non-surgical treatment options have failed to provide pain relief and/or maintain functionality. These may include:
• Physical therapy
• Specialty braces or footwear
• Icing and/or heat treatments
• Pain medication
• Steroid injections
• Walking aids

Diagnostic Procedures for Evaluating Ankle Conditions

Your surgeon will evaluate your ankle by performing a physical examination and taking a detailed medical history, including information about any unsuccessful treatments that have been tried. They may also order further diagnostic imaging tests such as X-rays, CT scans, or MRIs.

Consulting With a Foot & Ankle Specialist for an Ankle Fusion

Ready to effectively treat ankle pain caused by arthritis with a permanent surgical solution? The world-class team of surgeons at Modern Orthopaedics of New Jersey is here to help. Contact our office today to book an appointment!

The Treatment Journey

Upon the initial visit, a detailed health history will be collected, along with a thorough physical exam assessing the extent of the problem. Next, X-ray imaging and sometimes advanced imaging, including CT scans, may be performed to assess the integrity of the ankle joint. Determination of the extent of the problem relies heavily on the inability to use the extremity in a pain-free manner to perform the activities of daily living. Review of prior conservative therapy and other conservative treatment measures will be discussed prior to the recommendation/ determination of an ankle fusion procedure appropriateness. 

Prior to surgery, it is important to have medical conditions reviewed by primary care physicians and any additional specialists as appropriate. The process of obtaining clearance for surgery may require additional testing, including lab work, X-rays, and cardiac examinations. It is required that patients quit smoking 8 weeks prior to surgery in order to allow for optimal healing. 

An ankle fusion procedure is performed using an anterior or lateral incision in order to get access to the joint. Alternatively the procedure can be performed arthroscopically. It requires adequate preparation of the joint, confirming appropriate alignment/positioning, and application of structurally sound hardware in order to maintain the corrected position. 

During the initial 4 days after surgery, a patient is expected to have pain and swelling, which is within the normal healing course. A short-term combination of pain medication will be prescribed in order to make the patient comfortable during the healing. Following the procedure, a specialized splint will be applied, and the patient will be provided crutches or a wheelchair in order to not put weight on the operative site. 

Physical therapy is an essential component of a successful ankle fusion surgery. As the ankle joint will be permanently locked in position, it is essential for peripheral joints and surrounding muscles to get acclimated to the changes and allow for the best functional outcome with as minimal pain as an end result. Following completion of the healing and full course of physical therapy, it is expected that patients will be able to perform their activities of daily living pain-free. It is worth noting that surrounding joints will compensate for the motion that was previously performed by the ankle joint. As well, there may be some difficulty experienced by patients to fit into tapered pants due to the decrease in foot motion. 

Ankle Fusion Techniques

Arthroscopic ankle fusions are performed using an optic camera and shaving instruments in order to prepare the joint with small incisions. Following this, percutaneous screws are applied to hold the correction and for the joint to fuse in optimal alignment. Traditional ankle fusions consist of an anterior or lateral incision. With these incision techniques, direct access to the joint is attained, followed by a subsequent takedown of the joint. This would then be followed by positioning the foot and ankle into optimal alignment and then applying hardware to maintain the position. For patients who may have open wounds or cannot tolerate internal fixation, an option would be to apply external fixation in a compressive manner at the level of the ankle joint to allow the patient to heal. 

At a certain point in the healing process, the patient will be asked to start walking in the external fixator frame in order to further stimulate bone healing/fusion. For patients with limb length discrepancy, multiplanar deformity, or excess bone loss, it may be helpful to apply a bone graft to help elevate the limb, fill in any voids present, and fill in any defects, respectively. The bone graft is sometimes autogenous, meaning it comes from the patient’s own body, such as their heel bone, leg bone or hip bone (iliac crest). In other instances, a cadaveric bone graft is used in order to limit any donor site complications to the patient. 

Risks and Complications

Like all foot and ankle surgery, ankle fusion comes with the risk of pain, swelling, infection, need for further surgery, the bones not fusing together, or the bones taking longer to fuse together, and issues with the implanted hardware. The risks of complications for ankle surgeries are generally low. However, sometimes they can occur, and you can rest assured that your surgeon, and the Modern Orthopaedic team will be by your side in every step of the healing journey until the finish line is reached. 

It is important to recognize specific signs and symptoms such as fever, chills, shortness of breath, chest pain, or calf pain when they present. It is important to call your provider immediately or present to the nearest emergency department if you experience these signs or symptoms. Additionally, worsening pain, swelling, redness, warmth, and white or yellow drainage following the initial few days of surgery may warrant urgent medical attention as well.

Cost and Insurance Considerations

The costs associated with an ankle fusion procedure depends on your specific insurance plan, your associated copays, deductibles and out of pocket maximums for the year. An in-depth discussion will be performed with you and a member of the Modern Orthopaedics billing department about the specific fees associated with all planned procedures to prevent any surprise bills. Elective ankle fusion surgery is covered by insurance when it is performed on a patient who has pain and deformity warranting the surgical correction.

Alternative Treatments

Physical therapy, Steroid injections, PRP injections, collagen, glucosamine chondroitin, and turmeric supplementation can help. Some alternative surgeries to ankle fusions include ankle arthroscopy, ankle arthrodiastasis, and ankle replacement surgery. 

Frequently Asked Questions

What is the recovery timeline following ankle fusion surgery?

You will not be able to place any weight on the affected joint for several weeks following ankle arthrodesis surgery and will need to use a knee scooter, crutches, or a wheelchair for mobility.

With your surgeon’s approval, you’ll receive a walking boot and, usually about 10-12 weeks after surgery, can start gentle weight-bearing without the boot. Ongoing physical therapy will be necessary throughout your recovery process, which may take between 6 and 12 months.

Why is ankle fusion preferred over other treatments?

The main benefit of ankle fusion surgery is that it reduces or eliminates arthritis pain in the ankle altogether and is meant to be a permanent solution. Your surgeon may also consider a total ankle replacement (ankle arthroplasty) and will explore which procedure may offer a preferred outcome based on your specific circumstances and health goals.

What are the long-term outcomes of ankle fusion surgery?

Approximately 90% of all ankle arthrodesis surgeries result in successful fusion of the ankle bones. This can mean a return to physical activities that were too painful to engage in prior to surgery.

What are the potential risks and complications of ankle fusion surgery?

Like all surgeries, ankle fusion surgery has certain inherent risks. These include:

• Infection
• Nerve or blood vessel damage
• Nonunion (failure of the ankle bones to fuse together)
• Misalignment of the bones
• Potential arthritis in other joints due to slight changes in biomechanics