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 joints in the foot; thus maintaining very good function (see videos below of gait and foot motion after ankle arthrodesis).
Patients' gait and foot motion 6 months following their ankle fusions
A Patient's Journey...
" I took to Mr Mahadevan on first contact. He explained to me all aspects of the procedure that I was contemplating and presented all options in a frank and honest way. I needed a strong advocate for the procedure suggested and he did not waiver at any stage in assuring me that ankle fusion was the right choice. In this he presented irrefutable evidence that, after some months, matters would turn out well. He was so correct in his judgement. Once decided the procedure was carried out with all appropriate feedback and reassurance throughout. The recovery period was a hard and rocky road of three months plaster cast but I was well prepared for what to expect. Monitoring visits and three plaster changes were carried out by him personally and this unusual (in my experience) and welcome involvement provided every opportunity to discuss progress and any concerns. It has now been seven months and I am totally recovered and able to do so much more than I could previously. This means 20 Km road bike, 40 minutes of Pilates, and 3km dog walk each and every fay. 18 holes of golf are a breeze. In conclusion, this is all down to Mr Mahadevan’s expertise. I am so grateful to him and all of his staff for what they have done for me."
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 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?
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
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.