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. But in some patients after major trauma, or with large deformity it may not be possible to do this via keyhole. In these patients an open ankle fusion will be recommended.

Depending on the specific case, this can be performed via an incision over the front of the ankle, or on the side of the ankle. The cartilage is then removed from the joint any defects are grafted and the ankle joint is held strongly in position with a plate and screws.

Figure 1: patient who has undergone open ankle fusion with due to severe ankle arthritis in the setting of trauma

Figure 2: one type of plate that can be used for open ankle fusion

Success rates: union/fusion is achieved in 85-93% of patients in most large scale studies [1].

 

Post-operative plan:

  • Surgery is typically a 1-2 night 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] Townshend D, Di Silvestro M, Krause F, Penner MJ, Younger A, Glazebrook M, et al. Arthroscopic Versus Open Ankle Arthrodesis: A Multicenter Comparative Case Series. Journal of Bone and Joint Surgery, American Volume 2013;95(2):98–102.