Arthroscopic (keyhole) ankle fusion

In end stage arthritis the bones of the ankle joint may need to be joined together (fused) to relieve pain. In certain cases this will be suitable for an arthroscopic (keyhole) ankle fusion. Patients who are best suited to this procedure are those without large deformity at the ankle.

However not every case of ankle fusion is suitable.

This is done via two incisions at the front of the ankle and the joint surfaces are prepared and all the cartilage is removed. Screws are then used to compress the joint surface together to achieve fusion.

Figure 1: arthroscopic ankle fusion in a patient with end stage arthritis.

Figure 2: arthroscopic view of an ankle joint being prepared for fusion

Success rates: union/fusion is achieved in 90-94% of patients in most large scale studies [1].

 

Post-operative plan:

  • Surgery is typically a day case or overnight stay

  • a nerve block is administered to help with pain

  • 0-2 weeks: elevation at home, non weight bearing

  • 4-6 weeks: partial weight bearing in CAMboot

  • 6-10 weeks onwards: weight bearing in a CAMboot

  • 10 weeks onwards: wean out of CAMboot and progress to walking in normal shoes. Ongoing recovery up to 1 year after surgery

Download post-operative care guide 

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems

  • Scar sensitivity

  • Non union (bones not fusing) – 5-10%

  • Further procedures including removal of hardware in up to 20% of patients, due to screw head prominence just above ankle joint.

  • Development of arthritis in the joints below and in front of the ankle, 30% on Xrays at 10 years post ankle fusion


[1] Jones CR, Wong E, Applegate GR, Ferkel RD. Arthroscopic Ankle Arthrodesis: A 2-15 Year Follow-up Study. Arthroscopy 2018;34(5):1641–1649.

[2] Winson IG, Robinson D, Allen PE. Arthroscopic ankle arthrodesis. JBJS (Br). 2005 Mar 1;87(3):343–7.