What is an ankle fusion ?

An operation is done to remove the cartilage from between the bones of your ankle and fuse them into one bone. This eliminates joint motion and reduces pain coming from the arthritic joint. Ankle fusion is also known as ankle arthrodesis.

This procedure is done for a painful arthritic ankle joint, where other treatment options like joint replacement are not suitable and more conservative treatments such as anti-inflammatory medication, anaesthetic injections and arthroscopy have been tried without success. The overall aim is to reduce the pain caused by the arthritis. The ankle joint is made completely stiff, but you will still be able to move the joint below the ankle and the joints in the foot. 

Ankle arthrodesis - gait after procedure
Foot movement after ankle fusion

Gait and foot motion six months following ankle fusion

 

How is it done?

This procedure is usually performed under general anaesthetic and frequently combined with a nerve block for pain relief. Occasionally a spinal anaesthetic may be recommended. The operation takes about 1.5 to 2 hours. You will be admitted on the day of operation and kept in overnight.

Surgery may be done either through a keyhole or open operation depending on the individual circumstances. The damaged joint surfaces are removed and prepared down to bleeding bone and the joint is then held together with screws or plates (see X-rays below).

Your leg will be in plaster or a boot for up to 12 weeks. You will be on crutches with little weight on the operated leg for the initial 6 weeks. After 6 weeks, you may start increasing your weight-bearing through the plaster or boot.

Ankle arthritis

Ankle fusion with screws

 

Aftercare and FAQs

It is important to keep the leg elevated as much as possible especially for the first 2 weeks. Your first clinic follow-up is usually 12 to 14 days after surgery.

Wound care – The plaster should be kept dry. At your first clinic appointment, wound inspection and suture removal will be undertaken.

Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work until the boot / cast is removed.

Recovery - Your ankle will continue to improve up to 12 months following surgery. Intermittent swelling and aches are common in the initial phase of recovery.

Driving - You will not be able to drive for 12 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.

 

Flying after surgery - It is generally recommended to wait at least six weeks to fly. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.

 

What are the surgical risks?

  • Infection

  • Nerve damage – causing numbness and painful scar

  • Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – to reduce this risk you would be prescribed heparin injections for a few weeks (unless contraindicated)

  • Delayed union or non-union of the fusion - 5 to 8% of operations do not fuse and require further treatment (revision). This means that the bones do not knit together firmly. The risk of non-union is increased if you smoke.

  • Residual pain in other joints

  • Prolonged recovery

 

It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.

 

Mr Dev Mahadevan
Consultant Foot and Ankle Surgeon

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