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Ankle Fusion (Arthrodesis)

What is ankle fusion?

Ankle fusion, also called ankle arthrodesis, is a surgical procedure that is used to treat severe ankle arthritis and pain. When conservative and non-surgical treatments for ankle pain have been explored and fail to adequately provide pain relief, ankle fusion surgery may a reasonable treatment option to consider. Ankle fusion surgery will permanently stiffen the ankle joint so it can no longer bend and cause pain from arthritis. However, it means that there will no longer be any up and down motion in the ankle joint.

When is ankle fusion a good option?

Ankle fusion surgery can be considered as a last-line treatment option for patients with severe ankle arthritis who have tried non-surgical treatment options without sufficient pain relief. Patients who have ankle fusion surgery will have a permanently stiff joint and may not be able to return to certain activities. Total ankle replacement is a newer treatment option that allows patients to regain a wider range of motion and often return to active lifestyles, but not all patients are good candidates for ankle replacement.

What happens during the ankle fusion procedure?

There are several surgical approaches to ankle fusion, depending on the extent of arthritis, severity of deformity, or surgeon preference. However, all techniques used achieve the same outcome of permanently eliminating the joint so it will no longer bend and create pain. Cartilage is removed from either side of the joint surfaces to expose the underlying bone and create an even surface for bone fusion. Next, the bones making up the ankle joint are placed in the proper position for fusion. Screws or other metal implants may be used to hold the bones in position while they heal. Occasionally, the metal screws can be felt through the skin and cause discomfort to some patients and may be removed if they become problematic. However, if they are not causing discomfort to the patient, they do not need to be removed.

How long does the ankle fusion procedure last?

The goal of ankle fusion surgery is to provide complete pain relief for the patient for the rest of their life. However, every patient is different and there is a possibility that some may experience more pain relief than others. Also, stopping the motion at the ankle joint may cause increased stresses on intact, nearby joints in the foot. This can lead to eventual over-use degeneration of the neighboring joints.

How long must patients stay in the hospital after the ankle fusion procedure?

Patients can expect to stay in the hospital for one night to ensure that pain is well managed before going home. Patients can expect to use crutches, a cane, or other walking aid for 8-12 weeks while new bone formation takes place. After 8-12 weeks, patients will be placed in a walking cast or boot for comfort and progressed to gradual weight bearing on the operative side. Complete bone healing and fusion can be expected between 4-6 months.

What are the benefits and risks of ankle fusion?

The benefit of ankle fusion is pain relief from severe arthritis. The main risk of ankle fusion is nonunion, which happens when the bones do not completely fuse. Patients who smoke cigarettes have a higher incidence of nonunion and smoking cessation is encouraged prior to surgery. For more information, please see our page on encouraging bone healing. Other risks associated with ankle fusion are infection, difficulty with wound healing, and the possibility of needing shoe modifications for walking.