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Ankle Replacement or Ankle Fusion for Painful Arthritis of the Ankle?

The ankle is significantly smaller than the knee joint but must accept the same body weight forces. It is comprised of the end of the leg bones (tibia and fibula) and the ankle bone (talus). Ankle arthritis is typically defined by pain, stiffness, swelling and often instability (giving way) and deformity. Unlike hip and knee arthritis that are generally caused by “wear and tear” (also known as osteoarthritis), ankle arthritis is mostly caused by injury. Some of the common injuries that cause arthritis are ankle fractures and ankle sprains. Repetitive ankle sprains can damage the cartilage and permanently stretch out the ligaments that support the joint.

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 When is an Ankle Fusion a Better Idea Than an Ankle Replacement?

Ankle arthrodesis or fusion procedures have been around for many years. They were previously considered the gold standard to treat end-stage arthritis of the ankle before ankle replacements were developed and became more reliable and popular. Although ankle replacements have become much more common, ankle arthrodesis procedures are still a good option to treat arthritis and deformity in the ankle in certain patients. Some of the common reasons we recommend an ankle fusion over replacement are severe valgus deformities of the ankle, neuropathy or lack of feeling in the foot and ankle, Charcot ankle deformity, and severe obesity.

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Ankle Fusion or Ankle Replacement?

Ankle fusion (arthrodesis) involves cleaning the worn-out ankle joint and fusing the bones together with screws, plates, and bone grafts. Ankle fusion relieves pain, but it also limits your ankle’s range of motion. The limited mobility can change how you walk, and that can cause wear and tear, and ultimately painful arthritis, in other parts of your ankle, knee, and foot. Recovery is longer with ankle fusion than ankle replacement. Patients can spend up to 10 to 12 weeks in a cast. Because the ankle joint is locked in place, physical therapy is not part of the recovery process. Ankle replacement is a newer option. The procedure, also known as ankle arthroplasty, replaces the arthritic ankle joint with a metal and plastic prosthesis.

Ankle Fusion Pros and Cons

One of the outcomes from ankle fusion surgery is that there can be a loss of range in motion in the ankle joint since two or more ankle bones are fused together during the surgery. Due to the fusion of the ankle bones, this may limit some activities you were able to perform prior to surgery. As with all surgeries, there is also a potential risk for complications. Consult with your surgeon healthcare provider to learn if ankle fusion is right for you.

Ankle Fusion – A Patient's Perspective

The problem was described by the surgeon following a further examination. He told me that the best thing would be an ankle fusion rather than an ankle replacement, due to the poor state of the joint. It is, he said, a relatively simple operation, although he warned that recovery time would be considerably longer than with the previous operations.

Pros and Cons of Ankle Fusion Surgery

Despite the high level of pain relief, there are drawbacks to ankle fusion that make it a less attractive option for some people, including loss of ankle flexibility, complications, and possible need for revision.

What Can Be Done With An Ankle Fusion That Hasn't Healed?

One common complication with ankle fusion is called a nonunion. This occurs when the two primary bones involved in the fusion, the tibia and the talus, do not grow together and form a united bone. This can happen for several reasons, but if it does happen, it leads to long-term pain and difficulty with walking.