Pros and Cons of Ankle Fusion Surgery

A Surgical Option for People With Severe Ankle Arthritis

When conservative treatments for ankle arthritis fail to provide relief, it may be time to consider surgery. There are several options for this. When pain caused by ankle arthritis is severe and unrelenting, surgeons will often consider a type of surgery called ankle arthrodesis, also known as ankle fusion.

a man with his ankle elevated and immobilized
 Chaikom / Getty Images

Background

Pain from ankle arthritis is caused when cartilage that caps the bones in your joints begins to wear away. When this occurs, the bones can rub directly against each other, triggering severe pain while accelerating joint damage.

There are three bones that make up the ankle joint:

  • The lower end of the tibia (shinbone)
  • The lower end of the fibula (the smaller bone of the lower leg)
  • The talus (the bone that fits into the socket formed by the tibia and fibula and rests on the heel bone)

Articular cartilage lines the inside of the ankle joint. Normally, the cartilage is about a quarter of an inch thick. In people with severe osteoarthritis ("wear-and-tear arthritis"), much or all of this cartilage will be lost.

Ankle fusion is a surgical procedure that removes the surfaces of the ankle joint so that the tibia and talus bones can fuse together. By doing so, the bones are stabilized and can no longer rub together, reducing pain.

Despite the high level of pain relief, there are drawbacks to ankle fusion that make it a less attractive option for some people.

Candidates for Surgery

People who have severe ankle damage from arthritis or a past injury may be candidates for ankle fusion. Candidates will usually have ankle pain that is so severe that it interferes with walking and daily activities.

Prior to recommending surgery, the orthopedic surgeon will want to ensure that all conservative options have been explored (including pain medications, steroid injections, physical therapy, and orthotics). If these interventions fail to provide relief, surgery may be the next logical step.

Ankle fusion is not the only option. For people with less cartilage damage, minimally invasive resurfacing surgery may be used to remove bone spurs that are causing pain. For individuals with severe bone damage and loss of mobility, joint replacement surgery may be the more appropriate option.

Types of Surgery

Ankle arthrodesis can be performed either as an open surgery or minimally invasive arthroscopic surgery. Each has its benefits and limitations:

  • Open surgery is a traditional form of surgery in which a large incision is made with a scalpel to access the surgical site. Although a larger wound generally means a longer recovery time, it may be more appropriate if the ankle damage is extensive.
  • Arthroscopic surgery is a form of laparoscopy in which specialized tools access the surgical site via small "keyhole" incisions. It is an effective form of surgery with faster recovery times but may not be the best option for everyone.

What to Expect

Ankle fusion surgery is typically performed under general anesthesia with a regional block. Whether the surgery is open or arthroscopic, the operation itself tends to follow the same steps:

  1. An incision is made to access the joint. For open surgery, this would involve one large incision. For arthroscopic surgery, three tiny incisions would be made to insert the video-assisted scope (called the arthroscope) and specialized surgical tools.
  2. After the joint is opened, a surgical saw removes articular cartilage surfaces.
  3. The tibia and talus are then cut at angles so that they rest flat against the other. This allows the bones to fuse together naturally through a process called bone remodeling.
  4. If needed, permanent metal plates and screws may be used to fix the bones securely. If the ankle damage is severe, an external fixator (involving internal stabilizing rods and an external support scaffolding) may be recommended.

Recovery

After surgery, the operated leg is wrapped in a compression dressing and non-weight-bearing splint for 48 to 72 hours. After the splint is removed, a short fiberglass cast is applied and worn for the next 4 to 8 weeks. You will need to get around either on crutches or with some other assistive mobility device.

After 4 to 8 weeks, the cast is replaced with a walking cast or rigid boot for a further 6 to 8 weeks. At the end of this initial recovery period, an X-ray is taken to confirm that the bones have fused together.

If fusion has occurred, you can resume certain physical activities as swimming or stationary bicycling. With the input of your healthcare provider and physical therapist, you can gradually transition to activities that place more weight on the ankle until you are deemed fully recovered.

Benefits and Risks

The goal of ankle fusion is to relieve pain and restore function to the affected ankle. Although some people may be concerned that the fusion will affect their normal gait, most who need the surgery will have already lost significant range of motion in the joint and won't notice a difference.

An ankle fusion can often last a lifetime compared to an ankle replacement, which tends to have a higher failure rate. With that said, ankle fusions tend to have a higher rate of complications, including bone nonunion (when bones fail to fuse), or malunion (when bones heal in the wrong position).

Ankle Fusion vs. Ankle Replacement

According to a 2017 review in the Journal of Orthopedic Surgery and Research, 26.9% of people who underwear ankle fusion surgery experienced complications versus 19.7% of those who had an ankle replacement. Even so, only 5.4% of ankle fusion surgeries required revision surgery compared to 7.9% of ankle replacements.

If ankle fusion is recommended, it is important to weigh the pros and cons to decide if it's the best option for you as an individual.

Pros
  • Immediate pain relief

  • Greater joint stability

  • Greater ability to bear weight without pain

  • Improved mobility to perform daily tasks

Cons
  • Loss of ankle flexibilty

  • Less appropriate for active people compared to ankle replacement

  • Risk of complications is high

  • One in 20 people require revision surgery

A Word From Verywell

Ankle fusion is a very effective surgery, albeit one that comes with risks. If in doubt as to whether it is the right option for you, do not hesitate to seek a second opinion from an orthopedic specialist.

There may not only be other surgical and non-surgical options to consider, but there are also different ankle fusion techniques that some surgeons use over others. Keep an open mind and ask as many questions as you need to make a fully informed choice.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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